Mouen Khashab - Academia.edu (original) (raw)
Papers by Mouen Khashab
Gastrointestinal Endoscopy, 2015
Endoscopy, Jan 7, 2015
Precise identification of the gastroesophageal junction (GEJ) is a challenging prerequisite for a... more Precise identification of the gastroesophageal junction (GEJ) is a challenging prerequisite for adequate length of an esophageal myotomy. Multiple standard methods to identify the GEJ have been described; however, a more objective modality is needed to ensure effective peroral endoscopic myotomy (POEM). In the double-endoscope transillumination for extent confirmation technique (DETECT), an ultraslim gastroscope is passed to the most distal aspect of the submucosal tunnel created during POEM. A regular gastroscope is advanced into the stomach, and the visualization of transillumination from the ultraslim gastroscope enables identification of the extent of the submucosal tunnel. A total of 10 patients underwent POEM with DETECT. Initial submucosal tunneling was performed based on a determination of the GEJ location via standard methods. DETECT indicated the tunnel extent to be inadequate in 50% of patients, and the tunnel was extended a further 1 to 2cm. The mean initial tunnel lengt...
Gastrointestinal endoscopy clinics of North America, 2011
The Roux-en-Y gastric bypass (RYGB) accounts for more than 60% of bariatric procedures performed ... more The Roux-en-Y gastric bypass (RYGB) accounts for more than 60% of bariatric procedures performed in the United States today. The RYGB anatomy poses particular challenges to interventional endoscopists who intend to access the papilla. Deep enteroscopy-assisted endoscopic retrograde cholangiopancreatography seems to be the least invasive technique for this purpose, and is often the best initial choice. However, considerable experience is needed to optimize the success rate of reaching the biliopancreatic limb, with subsequent successful cannulation, and which approach is taken should be determined on a case-by-case basis.
Endoscopy, Jan 31, 2015
Background and study aims: Endoscopic cryotherapy has been used successfully for the ablation of ... more Background and study aims: Endoscopic cryotherapy has been used successfully for the ablation of Barrett's esophagus but outcome data are limited. The aim of this study was to assess the long-term safety and efficacy of carbon dioxide (CO2) cryotherapy as primary or rescue treatment for Barrett's esophagus with high grade dysplasia (HGD) or neoplasia. Patients and methods: This was a retrospective, single-center, nonrandomized study carried out in an academic, tertiary care center and affiliated community hospital. A total of 78 patients with neoplastic Barrett's esophagus who had not undergone previous ablation (treatment-naïve group) or who had persistent or recurrent neoplasia despite previous treatment (rescue treatment group) were enrolled. Visible Barrett's lesions, when present, were removed by endoscopic mucosal resection, which was followed by CO2 cryotherapy until neoplasia had been eradicated, or intervening therapy was necessary, or treatment was consider...
Gastrointestinal Endoscopy, 2014
Background: The 19g EUS needle is the needle of choice when performing interventional procedures ... more Background: The 19g EUS needle is the needle of choice when performing interventional procedures as it allows easy passage of a guidewire and rapid injection of solution. However, due to its rigidity, access with the standard 19-gauge needle is often difficult when the echoendoscope is in a long or angulated position, such as the duodenum. A needle made of nitinol (Expect 19 Flex, Boston Scientific, Natick, MA) has been developed with enhanced flexibility. This needle has been shown to be successful in tissue acquisition through a transduodenal approach though it is not known if it will aid in interventional EUS. Aims: To evaluate the efficacy and safety of the flexible 19-gauge needle in performing interventional EUS procedures. Methods: This was an international multicenter retrospective analysis of consecutive interventional EUS procedures which utilized the flexible 19g needle for a variety of clinical indications. Patient records from five tertiary-care centers (4 US, 1 European) were abstracted and entered into a pre-defined database. Outcomes included needle specific technical success (successful needle puncture and adequate insertion of accessory or solution), procedural technical success, and clinical success at long term follow up. Complications specifically attributable to needle insertion as well as all cause complications were recorded. An analysis was performed to determine if there was any difference in success and complication rates between transgastric and transduodenal access. Results: A total of 125 patients (mean age 66 yrs, 45.6% female) underwent 125 interventional EUS procedures between July 2012 and October 2013 . Malignant etiology was present in 51.2% of patients and the majority (86%) of the procedures were drainage in nature. EUS-guided biliary drainage (54.4%) was the most common indication followed by pancreatic pseudocyst drainage (23.2%). In the entire cohort, needle specific technical success occurred in 94.4% and procedural technical success occurred in 84.8% of cases. Complications specifically attributable to needle insertion occurred in 10.6% and the overall complication rate was 21.3% (infection being the most common). Clinical success occurred in 75.9% at a mean duration of follow up of 3.5 months. Outcomes by site of needle puncture : there was no difference in needle specific technical success or clinical success between the transgastric and trasnduodenal route. However, procedural technical success was significantly higher with transgastric access (90.00% vs. 73.8%, pZ0.046). Conclusions: This large multicenter study suggests that the flexible 19g needle was effective for use in interventional EUS procedures with an acceptable complication rate. The flexible nature of the needle allows similar procedural success between transgastric and transduodenal routes.
Gastrointestinal Endoscopy, 2014
Gastrointestinal endoscopy, Jan 15, 2014
Gastrointestinal endoscopy, Jan 25, 2014
Gastrointestinal endoscopy, Jan 26, 2015
Limited data exist on the use of peroral endoscopic myotomy (POEM) for therapy of spastic esophag... more Limited data exist on the use of peroral endoscopic myotomy (POEM) for therapy of spastic esophageal disorders (SEDs). To study the efficacy and safety of POEM for the treatment of patients with diffuse esophageal spasm, jackhammer esophagus, or type III (spastic) achalasia. Retrospective study. International, multicenter, academic institutions. All patients who underwent POEM for treatment of SEDs refractory to medical therapy at 11 centers were included. Eckardt score and adverse events. A total of 73 patients underwent POEM for treatment of SEDs (diffuse esophageal spasm 9, jackhammer esophagus 10, spastic achalasia 54). POEM was successfully completed in all patients, with a mean procedural time of 118 minutes. The mean length of the submucosal tunnel was 19 cm, and the mean myotomy length was 16 cm. A total of 8 adverse events (11%) occurred, with 5 rated as mild, 3 moderate, and 0 severe. The mean length of hospital stay was 3.4 days. There was a significant decrease in Eckard...
Nature Reviews Gastroenterology & Hepatology, 2011
Natural orifice transluminal endoscopic surgery (NOTES) has gained a great deal of attention from... more Natural orifice transluminal endoscopic surgery (NOTES) has gained a great deal of attention from gastroenterologists and surgeons all over the world since its introduction in 2000. The field of NOTES has advanced tremendously since that time and exciting and well-designed research has been reported. Both randomized controlled trials and results from large national and international registries have been published. Many experimental and clinical studies have discussed transesophageal, transgastric, transvaginal and transrectal access for a variety of NOTES procedures. Transvaginal access has been the most frequently reported NOTES access route in clinical trials. When suitable instruments become available, a true comparison of NOTES with current laparoscopic approaches can be realized.
Gastrointestinal Endoscopy, 2015
Current Gastroenterology Reports, 2009
Endoscopic retrograde cholangiopancreatography (ERCP) and endoscopic ultrasound are invaluable to... more Endoscopic retrograde cholangiopancreatography (ERCP) and endoscopic ultrasound are invaluable tools in the diagnostic and therapeutic evaluation and management of a variety of pancreatobiliary disorders. Along with a significant refinement in the equipment and techniques used has come a recent trend toward aggressive therapeutic interventions. Because of the technical nature of these procedures and the characteristics of the patients, post-procedural complications may occur, ranging from minor (requiring brief hospitalization) to severe (causing permanent disability or death). This review summarizes these complications and outlines strategies to minimize them.
Gastrointestinal Endoscopy, 2014
The over-the-scope clip (OTSC) provides more durable and full-thickness closure as compared with ... more The over-the-scope clip (OTSC) provides more durable and full-thickness closure as compared with standard clips. Only case reports and small case series have reported on outcomes of OTSC closure of GI defects. To describe a large, multicenter experience with OTSCs for the management of GI defects. Secondary goals were to determine success rate by type of defect and type of therapy and to determine predictors of treatment outcomes. Multicenter, retrospective study. Multiple, international, academic centers. Consecutive patients who underwent attempted OTSC placement for GI defects, either as a primary or as a rescue therapy. OTSC placement to attempt closure of GI defects. Long-term success of the procedure. A total of 188 patients (108 fistulae, 48 perforations, 32 leaks) were included. Long-term success was achieved in 60.2% of patients during a median follow-up of 146 days. Rate of successful closure of perforations (90%) and leaks (73.3%) was significantly higher than that of fistulae (42.9%) (P < .05). Long-term success was significantly higher when OTSCs were applied as primary therapy (primary 69.1% vs rescue 46.9%; P = .004). On multivariate analysis, patients who had OTSC placement for perforations and leaks had significantly higher long-term success compared with those who had fistulae (OR 51.4 and 8.36, respectively). Retrospective design and multiple operators with variable expertise with the OTSC device. OTSC is safe and effective therapy for closure of GI defects. Clinical success is best achieved in patients undergoing closure of perforations or leaks when OTSC is used for primary or rescue therapy. Type of defect is the best predictor of successful long-term closure.
Gastrointestinal Endoscopy, 2011
International Journal of Surgery Case Reports, 2012
Gastrointestinal Endoscopy, 2015
Endoscopy, Jan 7, 2015
Precise identification of the gastroesophageal junction (GEJ) is a challenging prerequisite for a... more Precise identification of the gastroesophageal junction (GEJ) is a challenging prerequisite for adequate length of an esophageal myotomy. Multiple standard methods to identify the GEJ have been described; however, a more objective modality is needed to ensure effective peroral endoscopic myotomy (POEM). In the double-endoscope transillumination for extent confirmation technique (DETECT), an ultraslim gastroscope is passed to the most distal aspect of the submucosal tunnel created during POEM. A regular gastroscope is advanced into the stomach, and the visualization of transillumination from the ultraslim gastroscope enables identification of the extent of the submucosal tunnel. A total of 10 patients underwent POEM with DETECT. Initial submucosal tunneling was performed based on a determination of the GEJ location via standard methods. DETECT indicated the tunnel extent to be inadequate in 50% of patients, and the tunnel was extended a further 1 to 2cm. The mean initial tunnel lengt...
Gastrointestinal endoscopy clinics of North America, 2011
The Roux-en-Y gastric bypass (RYGB) accounts for more than 60% of bariatric procedures performed ... more The Roux-en-Y gastric bypass (RYGB) accounts for more than 60% of bariatric procedures performed in the United States today. The RYGB anatomy poses particular challenges to interventional endoscopists who intend to access the papilla. Deep enteroscopy-assisted endoscopic retrograde cholangiopancreatography seems to be the least invasive technique for this purpose, and is often the best initial choice. However, considerable experience is needed to optimize the success rate of reaching the biliopancreatic limb, with subsequent successful cannulation, and which approach is taken should be determined on a case-by-case basis.
Endoscopy, Jan 31, 2015
Background and study aims: Endoscopic cryotherapy has been used successfully for the ablation of ... more Background and study aims: Endoscopic cryotherapy has been used successfully for the ablation of Barrett's esophagus but outcome data are limited. The aim of this study was to assess the long-term safety and efficacy of carbon dioxide (CO2) cryotherapy as primary or rescue treatment for Barrett's esophagus with high grade dysplasia (HGD) or neoplasia. Patients and methods: This was a retrospective, single-center, nonrandomized study carried out in an academic, tertiary care center and affiliated community hospital. A total of 78 patients with neoplastic Barrett's esophagus who had not undergone previous ablation (treatment-naïve group) or who had persistent or recurrent neoplasia despite previous treatment (rescue treatment group) were enrolled. Visible Barrett's lesions, when present, were removed by endoscopic mucosal resection, which was followed by CO2 cryotherapy until neoplasia had been eradicated, or intervening therapy was necessary, or treatment was consider...
Gastrointestinal Endoscopy, 2014
Background: The 19g EUS needle is the needle of choice when performing interventional procedures ... more Background: The 19g EUS needle is the needle of choice when performing interventional procedures as it allows easy passage of a guidewire and rapid injection of solution. However, due to its rigidity, access with the standard 19-gauge needle is often difficult when the echoendoscope is in a long or angulated position, such as the duodenum. A needle made of nitinol (Expect 19 Flex, Boston Scientific, Natick, MA) has been developed with enhanced flexibility. This needle has been shown to be successful in tissue acquisition through a transduodenal approach though it is not known if it will aid in interventional EUS. Aims: To evaluate the efficacy and safety of the flexible 19-gauge needle in performing interventional EUS procedures. Methods: This was an international multicenter retrospective analysis of consecutive interventional EUS procedures which utilized the flexible 19g needle for a variety of clinical indications. Patient records from five tertiary-care centers (4 US, 1 European) were abstracted and entered into a pre-defined database. Outcomes included needle specific technical success (successful needle puncture and adequate insertion of accessory or solution), procedural technical success, and clinical success at long term follow up. Complications specifically attributable to needle insertion as well as all cause complications were recorded. An analysis was performed to determine if there was any difference in success and complication rates between transgastric and transduodenal access. Results: A total of 125 patients (mean age 66 yrs, 45.6% female) underwent 125 interventional EUS procedures between July 2012 and October 2013 . Malignant etiology was present in 51.2% of patients and the majority (86%) of the procedures were drainage in nature. EUS-guided biliary drainage (54.4%) was the most common indication followed by pancreatic pseudocyst drainage (23.2%). In the entire cohort, needle specific technical success occurred in 94.4% and procedural technical success occurred in 84.8% of cases. Complications specifically attributable to needle insertion occurred in 10.6% and the overall complication rate was 21.3% (infection being the most common). Clinical success occurred in 75.9% at a mean duration of follow up of 3.5 months. Outcomes by site of needle puncture : there was no difference in needle specific technical success or clinical success between the transgastric and trasnduodenal route. However, procedural technical success was significantly higher with transgastric access (90.00% vs. 73.8%, pZ0.046). Conclusions: This large multicenter study suggests that the flexible 19g needle was effective for use in interventional EUS procedures with an acceptable complication rate. The flexible nature of the needle allows similar procedural success between transgastric and transduodenal routes.
Gastrointestinal Endoscopy, 2014
Gastrointestinal endoscopy, Jan 15, 2014
Gastrointestinal endoscopy, Jan 25, 2014
Gastrointestinal endoscopy, Jan 26, 2015
Limited data exist on the use of peroral endoscopic myotomy (POEM) for therapy of spastic esophag... more Limited data exist on the use of peroral endoscopic myotomy (POEM) for therapy of spastic esophageal disorders (SEDs). To study the efficacy and safety of POEM for the treatment of patients with diffuse esophageal spasm, jackhammer esophagus, or type III (spastic) achalasia. Retrospective study. International, multicenter, academic institutions. All patients who underwent POEM for treatment of SEDs refractory to medical therapy at 11 centers were included. Eckardt score and adverse events. A total of 73 patients underwent POEM for treatment of SEDs (diffuse esophageal spasm 9, jackhammer esophagus 10, spastic achalasia 54). POEM was successfully completed in all patients, with a mean procedural time of 118 minutes. The mean length of the submucosal tunnel was 19 cm, and the mean myotomy length was 16 cm. A total of 8 adverse events (11%) occurred, with 5 rated as mild, 3 moderate, and 0 severe. The mean length of hospital stay was 3.4 days. There was a significant decrease in Eckard...
Nature Reviews Gastroenterology & Hepatology, 2011
Natural orifice transluminal endoscopic surgery (NOTES) has gained a great deal of attention from... more Natural orifice transluminal endoscopic surgery (NOTES) has gained a great deal of attention from gastroenterologists and surgeons all over the world since its introduction in 2000. The field of NOTES has advanced tremendously since that time and exciting and well-designed research has been reported. Both randomized controlled trials and results from large national and international registries have been published. Many experimental and clinical studies have discussed transesophageal, transgastric, transvaginal and transrectal access for a variety of NOTES procedures. Transvaginal access has been the most frequently reported NOTES access route in clinical trials. When suitable instruments become available, a true comparison of NOTES with current laparoscopic approaches can be realized.
Gastrointestinal Endoscopy, 2015
Current Gastroenterology Reports, 2009
Endoscopic retrograde cholangiopancreatography (ERCP) and endoscopic ultrasound are invaluable to... more Endoscopic retrograde cholangiopancreatography (ERCP) and endoscopic ultrasound are invaluable tools in the diagnostic and therapeutic evaluation and management of a variety of pancreatobiliary disorders. Along with a significant refinement in the equipment and techniques used has come a recent trend toward aggressive therapeutic interventions. Because of the technical nature of these procedures and the characteristics of the patients, post-procedural complications may occur, ranging from minor (requiring brief hospitalization) to severe (causing permanent disability or death). This review summarizes these complications and outlines strategies to minimize them.
Gastrointestinal Endoscopy, 2014
The over-the-scope clip (OTSC) provides more durable and full-thickness closure as compared with ... more The over-the-scope clip (OTSC) provides more durable and full-thickness closure as compared with standard clips. Only case reports and small case series have reported on outcomes of OTSC closure of GI defects. To describe a large, multicenter experience with OTSCs for the management of GI defects. Secondary goals were to determine success rate by type of defect and type of therapy and to determine predictors of treatment outcomes. Multicenter, retrospective study. Multiple, international, academic centers. Consecutive patients who underwent attempted OTSC placement for GI defects, either as a primary or as a rescue therapy. OTSC placement to attempt closure of GI defects. Long-term success of the procedure. A total of 188 patients (108 fistulae, 48 perforations, 32 leaks) were included. Long-term success was achieved in 60.2% of patients during a median follow-up of 146 days. Rate of successful closure of perforations (90%) and leaks (73.3%) was significantly higher than that of fistulae (42.9%) (P < .05). Long-term success was significantly higher when OTSCs were applied as primary therapy (primary 69.1% vs rescue 46.9%; P = .004). On multivariate analysis, patients who had OTSC placement for perforations and leaks had significantly higher long-term success compared with those who had fistulae (OR 51.4 and 8.36, respectively). Retrospective design and multiple operators with variable expertise with the OTSC device. OTSC is safe and effective therapy for closure of GI defects. Clinical success is best achieved in patients undergoing closure of perforations or leaks when OTSC is used for primary or rescue therapy. Type of defect is the best predictor of successful long-term closure.
Gastrointestinal Endoscopy, 2011
International Journal of Surgery Case Reports, 2012