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Papers by nitin kumar

Journal of Fusion Energy, 2010

Abstract In this paper the design of 140 GHz, 1.5 MW gyrotron interaction cavity is described in ... more Abstract In this paper the design of 140 GHz, 1.5 MW gyrotron interaction cavity is described in detail. The interaction cavity is designed and simulated by using Particle-in-Cell code for TE 24, 8 operating mode. The obtained simulation results show more than 1.5 MW of ...

SSRN Electronic Journal, 2004

... 1 Deepak Khatri and Nitin Kumar 2 1The authors would like to thank Rudra Sensarma for his sup... more ... 1 Deepak Khatri and Nitin Kumar 2 1The authors would like to thank Rudra Sensarma for his support and comments. All the rest of the errors are ours. ... competitive forces, they would perform efficiently irrespective of the sector if belongs (Sumon and Dimova, 2003). ...

2011 Annual IEEE India Conference, 2011

The Journal of Physical Chemistry C, 2009

PLoS ONE, 2012

Background: Regional genomic copy number alterations (CNA) are observed in the vast majority of c... more Background: Regional genomic copy number alterations (CNA) are observed in the vast majority of cancers. Besides specifically targeting well-known, canonical oncogenes, CNAs may also play more subtle roles in terms of modulating genetic potential and broad gene expression patterns of developing tumors. Any significant differences in the overall CNA patterns between different cancer types may thus point towards specific biological mechanisms acting in those cancers. In addition, differences among CNA profiles may prove valuable for cancer classifications beyond existing annotation systems.

Medicinal Research Reviews, 2010

Journal of Colloid and Interface Science, 2003

Super-spreading trisiloxane surfactants are a class of amphiphiles which consist of nonpolar tris... more Super-spreading trisiloxane surfactants are a class of amphiphiles which consist of nonpolar trisiloxane headgroups (((CH 3) 3-Si-O) 2-Si(CH 3)(CH 2) 3-) and polar parts composed of between four and eight ethylene oxides (ethoxylates,-OCH 2 CH 2-). Millimeter-sized aqueous drops of trisiloxane solutions at concentrations well above the critical aggregate concentration spread rapidly on very hydrophobic surfaces, completely wetting out at equilibrium. The wetting out can be understood as a consequence of the ability of the trisiloxanes at the advancing perimeter of the drop to adsorb at the air/aqueous and aqueous/hydrophobic solid interfaces and to reduce considerably the tensions of these interfaces, creating a positive spreading coefficient. The rapid spreading can be due to maintaining a positive spreading coefficient at the perimeter as the drop spreads. However, the air/aqueous and solid/aqueous interfaces at the perimeter are depleted of surfactant by interfacial expansion as the drop spreads. The spreading coefficient can remain positive if the rate of surfactant adsorption onto the solid and fluid surfaces from the spreading aqueous film at the perimeter exceeds the diluting effect due to the area expansion. This task is made more difficult by the fact that the reservoir of surfactant in the film is continually depleted by adsorption to the expanding interfaces. If the adsorption cannot keep pace with the area expansion at the perimeter, and the surface concentrations become reduced at the contact line, a negative spreading coefficient which retards the drop movement can develop. In this case, however, a Marangoni mechanism can account for the rapid spreading if the surface concentrations at the drop apex are assumed to remain high compared to the perimeter so that the drop is pulled out by the higher tension at the perimeter than at the apex. To maintain a high apex concentration, surfactant adsorption must exceed the rate of interfacial dilation at the apex due to the outward flow. This is conceivable because, unlike that at the contact line, the surfactant reservoir in the liquid at the drop center is not continually depleted by adsorption onto an expanding solid surface. In an effort to understand the rapid spreading, we measure the kinetic rate constants for adsorption of unaggregated trisiloxane surfactant from the sublayer to the air/aqueous surface. The kinetic rate of adsorption, computed assuming the bulk concentration of monomer to be uniform and undepleted, represents the fastest that surfactant monomer can adsorb onto the air/aqueous surface in the absence of direct adsorption of aggregates. The kinetic constants are obtained by measuring the dynamic tension relaxation as trisiloxanes adsorb onto a clean pendant bubble interface. We find that the rate of kinetic adsorption is only of the same order as the area expansion rates observed in superspreading, and therefore the unaggregated flux cannot maintain very high surface concentrations at the air/aqueous interface, either at the apex or at the perimeter. Hence in order to maintain either a positive spreading coefficient or a Marangoni gradient, the surfactant adsorptive flux needs to be augmented, and the direct adsorption of aggregates (which in the case of the trisiloxanes are bilayers and vesicles) is suggested as one possibility.

Journal of Coatings Technology and Research, 2011

International Journal of Thermophysics, 2011

Thermal and structural analysis for a 120 GHz, 1 MW gyrotron interaction cavity and the effect of... more Thermal and structural analysis for a 120 GHz, 1 MW gyrotron interaction cavity and the effect of structural deformation on the operational mode excitation is presented. Finite element analysis codes ANSYS and COSMOS have been used for the thermal and structural simulation. The values of the water flow rate and the hydraulic diameter of the outer jacket have been optimized. The effect of the maximum radial expansion of the interaction cavity on eigenfrequency and mode excitation has also been analyzed. The change in eigenfrequency for the operating mode due to thermal expansion is 0.606 GHz. This value is very near the theoretically calculated value and under the tolerance limit of the maximum frequency deviation for the gyrotron operating mode.

Infrared Physics & Technology, 2012

Gastrointestinal Endoscopy, 2014

tablet application with an additional observer resulted in a 10.2% increase in the polyp detectio... more tablet application with an additional observer resulted in a 10.2% increase in the polyp detection rate, increasing the number of detected polyps by an average of 1.7 0.9 per procedure. Conclusions: Using the tablet software to increase the number of qualified participants is a valid approach to increasing the polyp detection rate for decreasing the incidence of colorectal cancer. The approach additionally allows for more effective medical training by enabling experienced physicians to more effectively highlight lesions and polyps using the endoscopic video. The proposed platform can be easily integrated into existing infrastructure for colonoscopy without interfering with the standard of care, and additionally be used for other types of endoscopy. Su1571 A Randomized Trial of Endoscopic Simulator Training in First Year Gastroenterology Fellows Pichamol Jirapinyo*, Vicki Bing, Nitin Kumar, Michele B. Ryan, Hiroyuki Aihara, Avlin B. Imaeda, Christopher C. Thompson Yale-New Haven Hospital, New Haven, CT; Division of Gastroenterology, Brigham & Women’s Hospital, Boston, MA Background: Training in endoscopy has traditionally relied upon clinical hands-on experience. Simulators may now allow the development of endoscopic skills in a non-clinical environment. Aim: To assess the effect of an endoscopic part-task simulator on trainees’ endoscopic performance. Methods: Simulator An endoscopic part-task training box consisting of 5 modules (snare polypectomy, retroflexion, torque, knob control and loop reduction/navigation) and a validated scoring system. Subjects: First year gastroenterology fellows from 2 academic institutions. Design: Fellows were randomized into 2 arms. The study arm practiced on the simulator for at least 45 minutes per week for the first 3 months of training, in addition to receiving traditional hands-on clinical training. The control arm received only hands-on clinical training. Outcomes: All fellows were assessed for their endoscopic skill performance using the Mayo Colonoscopy Skills Assessment Tool (MCSAT) and the simulator at month 0, 1 and 3. MCSAT scores, training box scores and the numbers of esophagoduodenoscopies (EGDs) and colonoscopies performed were collected. Statistical Analysis: Training box scores from the 2 arms were compared using a linear regression model adjusting for the numbers of EGDs and colonoscopies. Results: Ten first year gastroenterology fellows from 2 academic institutions participated in the study. Five were randomized into the study arm and 5 into the control arm. No participants had used the simulator prior to the study. Average numbers of prior EGDs and colonoscopies are shown in Table 1. There was no difference in total MCSAT hands-on skill scores between the 2 groups at month 1 (pO0.05), however, there was a trend for fellows in the simulator group taking less time (pZ0.09) to reach a farther landmark (hepatic flexure in simulator group vs. splenic flexure in control group (pZ0.22). Additionally, fellows in the study arm performed significantly better on the simulator at month 1 (Table 2; p!0.01), and showed significant improvement in training box performance from month 0 to month 1, compared to the control group (Table 2; p!0.05). At month 3, the control group eliminated this difference as reflected by similar MCSAT hands-on skill scores, time spent reaching the maximal insertion site, location of the farthest landmark reached without assistance and absolute simulator scores, compared to the simulator group (pO0.05 in all variables). Conclusion: The part-task endoscopic simulator provides a non-clinical environment for trainees to practice fundamental endoscopic maneuvers and become familiar with accessories prior to initiation of clinical cases, and during ongoing clinical training. This small sample size suggests that routine use of the simulator may improve technical endoscopic performance during the early phases of training, and larger studies are now needed. Table 1. Average numbers of esophagoduodenoscopies (EGDs) and colonoscopies (colons) performed www.giejournal.org Month 0 Month 1 Month 3 EGDs Colons EGDs Colons EGDs Colons Study arm (n [ 5) 4 4 31 21 62 38 Control arm (n [ 5) 4 1 24 20 51 25 Table 2. Average simulator scores

Gastrointestinal Endoscopy, 2014

Gastrointestinal Endoscopy, 2014

There is an urgent need to develop new and effective agents for cancer targeting. In this work, a... more There is an urgent need to develop new and effective agents for cancer targeting. In this work, a multivalent antibody is characterized in vivo in living animals. The antibody, termed ''trimerbody'', comprises a single-chain antibody (scFv) fragment connected to the N-terminal trimerization subdomain of collagen XVIII NC1 by a flexible linker. As indicated by computer graphic modeling, the trimerbody has a tripod-shaped structure with three highly flexible scFv heads radially outward oriented. Trimerbodies are trimeric in solution and exhibited multivalent binding, which provides them with at least a 100-fold increase in functional affinity than the monovalent scFv. Our results also demonstrate the feasibility of producing functional bispecific trimerbodies, which concurrently bind two different ligands. A trimerbody specific for the carcinoembryonic antigen (CEA), a classic tumor-associated antigen, showed efficient tumor targeting after systemic administration in mice bearing CEA-positive tumors. Importantly, a trimerbody that recognizes an angiogenesis-associated laminin epitope, showed excellent tumor localization in several cancer types, including fibrosarcomas and carcinomas. These results illustrate the potential of this new antibody format for imaging and therapeutic applications, and suggest that some laminin epitopes might be universal targets for cancer targeting.

Gastrointestinal Endoscopy, 2014

Gastrointestinal Endoscopy, 2014

Background-Larger gastrojejunal (GJ) anastomosis aperture is one independent predictor for weight... more Background-Larger gastrojejunal (GJ) anastomosis aperture is one independent predictor for weight regain after Roux-en-Y gastric bypass. Transoral outlet reduction (TORe) has proven safe and effective for treatment of weight regain by using a superficial-thickness (ST) suturing device. Full-thickness (FT) suturing devices are now available, potentially providing more effective results. Objective-To compare effectiveness of superficial-thickness with full-thickness TORe. Design-Matched cohort study: patients were matched sequentially by GJ anastomosis aperture, body mass index, and age. Setting-Tertiary-care center. Patients-A total of 59 consecutive patients undergoing full-thickness TORe were matched with 59 patients undergoing superficial-thickness TORe. All had GJ anastomosis apertures >20 mm. Intervention-Transoral outlet reduction. Main Outcome Measurements-Weight loss and rate of adverse events. Results-Post-TORe GJ anastomosis apertures were similar between groups (ST 6.9 ± 0.2 mm vs FT 7.1 ± 0.3 mm). Weight loss was greater at 6 months in the FT group (10.6 ± 1.8 kg in FT vs 4.4 ± 0.8 kg in ST; P < .01) and at 1 year (8.6 ± 2.5 kg in FT vs 2.9 ± 1.0 kg in ST; P < .01). Excess weight loss was greater in the FT group at 6 months (20.4 ± 3.3% in FT vs 8.1 ± 2.5% in ST; P < .01) and at 1 year (18.9 ± 5.4% in FT vs 9.1 ± 2.3% in ST; P = .03). Limitations-This was a single-center, retrospective, cohort study. Conclusion-There is level 1b evidence for effectiveness of TORe by using a superficial mucosal suturing device. This matched cohort study compared TORe by using the same ST suturing device with TORe by using a newer, FT suturing device and the same operative methods.

Gastrointestinal Endoscopy, 2013

incidentally diagnosed by an upper gastrointestinal endoscopy. All patients underwent Endoscopic ... more incidentally diagnosed by an upper gastrointestinal endoscopy. All patients underwent Endoscopic ultrasound to rule out deeper layers invasion. Lesions with ultrasonographic or endoscopic signs of lipomas were excluded. The size range was 1 to 4 cm in diameter. In 10 cases submucosal injection with saline serum and epinephrine was performed. Access to the submucosa was obtained using a needle knife to cut the mucosa and then the dissection was performed using a combination of blunt instruments: biopsy, foreign body or electrocoagulation forceps depending on each case. Once the resection was completed the edges were approached with endoscopic clips. In three patients under general anesthesia a tunel disection of the submucosa was performed removing the complete lesion. The remaining patients were made under propofol sedation. Results: All the lesions were completely resected without complications. Of the esophageal lesions, 3 were reported as leiomyomas, 4 GIST and 1 germinal cells tumor; the gastric lesions were reported as 2 lipomas, 3 GIST and 1 leiomyoma. Conclusion: The endoscopic blunt dissection and resection of subepitelial lesions in the esophagus and stomach is in trained hands; safe and efficient as long as the endoscopic ultrasound demonstrate integrity of the muscularis propria layer. The complete resection of the specimen in "one pice" allows the correct pathology report. It looks reasonable to combine different dissection techniques depending on the localization, size or any other particular characteristic in each case.

Journal of Fusion Energy, 2010

Abstract In this paper the design of 140 GHz, 1.5 MW gyrotron interaction cavity is described in ... more Abstract In this paper the design of 140 GHz, 1.5 MW gyrotron interaction cavity is described in detail. The interaction cavity is designed and simulated by using Particle-in-Cell code for TE 24, 8 operating mode. The obtained simulation results show more than 1.5 MW of ...

SSRN Electronic Journal, 2004

... 1 Deepak Khatri and Nitin Kumar 2 1The authors would like to thank Rudra Sensarma for his sup... more ... 1 Deepak Khatri and Nitin Kumar 2 1The authors would like to thank Rudra Sensarma for his support and comments. All the rest of the errors are ours. ... competitive forces, they would perform efficiently irrespective of the sector if belongs (Sumon and Dimova, 2003). ...

2011 Annual IEEE India Conference, 2011

The Journal of Physical Chemistry C, 2009

PLoS ONE, 2012

Background: Regional genomic copy number alterations (CNA) are observed in the vast majority of c... more Background: Regional genomic copy number alterations (CNA) are observed in the vast majority of cancers. Besides specifically targeting well-known, canonical oncogenes, CNAs may also play more subtle roles in terms of modulating genetic potential and broad gene expression patterns of developing tumors. Any significant differences in the overall CNA patterns between different cancer types may thus point towards specific biological mechanisms acting in those cancers. In addition, differences among CNA profiles may prove valuable for cancer classifications beyond existing annotation systems.

Medicinal Research Reviews, 2010

Journal of Colloid and Interface Science, 2003

Super-spreading trisiloxane surfactants are a class of amphiphiles which consist of nonpolar tris... more Super-spreading trisiloxane surfactants are a class of amphiphiles which consist of nonpolar trisiloxane headgroups (((CH 3) 3-Si-O) 2-Si(CH 3)(CH 2) 3-) and polar parts composed of between four and eight ethylene oxides (ethoxylates,-OCH 2 CH 2-). Millimeter-sized aqueous drops of trisiloxane solutions at concentrations well above the critical aggregate concentration spread rapidly on very hydrophobic surfaces, completely wetting out at equilibrium. The wetting out can be understood as a consequence of the ability of the trisiloxanes at the advancing perimeter of the drop to adsorb at the air/aqueous and aqueous/hydrophobic solid interfaces and to reduce considerably the tensions of these interfaces, creating a positive spreading coefficient. The rapid spreading can be due to maintaining a positive spreading coefficient at the perimeter as the drop spreads. However, the air/aqueous and solid/aqueous interfaces at the perimeter are depleted of surfactant by interfacial expansion as the drop spreads. The spreading coefficient can remain positive if the rate of surfactant adsorption onto the solid and fluid surfaces from the spreading aqueous film at the perimeter exceeds the diluting effect due to the area expansion. This task is made more difficult by the fact that the reservoir of surfactant in the film is continually depleted by adsorption to the expanding interfaces. If the adsorption cannot keep pace with the area expansion at the perimeter, and the surface concentrations become reduced at the contact line, a negative spreading coefficient which retards the drop movement can develop. In this case, however, a Marangoni mechanism can account for the rapid spreading if the surface concentrations at the drop apex are assumed to remain high compared to the perimeter so that the drop is pulled out by the higher tension at the perimeter than at the apex. To maintain a high apex concentration, surfactant adsorption must exceed the rate of interfacial dilation at the apex due to the outward flow. This is conceivable because, unlike that at the contact line, the surfactant reservoir in the liquid at the drop center is not continually depleted by adsorption onto an expanding solid surface. In an effort to understand the rapid spreading, we measure the kinetic rate constants for adsorption of unaggregated trisiloxane surfactant from the sublayer to the air/aqueous surface. The kinetic rate of adsorption, computed assuming the bulk concentration of monomer to be uniform and undepleted, represents the fastest that surfactant monomer can adsorb onto the air/aqueous surface in the absence of direct adsorption of aggregates. The kinetic constants are obtained by measuring the dynamic tension relaxation as trisiloxanes adsorb onto a clean pendant bubble interface. We find that the rate of kinetic adsorption is only of the same order as the area expansion rates observed in superspreading, and therefore the unaggregated flux cannot maintain very high surface concentrations at the air/aqueous interface, either at the apex or at the perimeter. Hence in order to maintain either a positive spreading coefficient or a Marangoni gradient, the surfactant adsorptive flux needs to be augmented, and the direct adsorption of aggregates (which in the case of the trisiloxanes are bilayers and vesicles) is suggested as one possibility.

Journal of Coatings Technology and Research, 2011

International Journal of Thermophysics, 2011

Thermal and structural analysis for a 120 GHz, 1 MW gyrotron interaction cavity and the effect of... more Thermal and structural analysis for a 120 GHz, 1 MW gyrotron interaction cavity and the effect of structural deformation on the operational mode excitation is presented. Finite element analysis codes ANSYS and COSMOS have been used for the thermal and structural simulation. The values of the water flow rate and the hydraulic diameter of the outer jacket have been optimized. The effect of the maximum radial expansion of the interaction cavity on eigenfrequency and mode excitation has also been analyzed. The change in eigenfrequency for the operating mode due to thermal expansion is 0.606 GHz. This value is very near the theoretically calculated value and under the tolerance limit of the maximum frequency deviation for the gyrotron operating mode.

Infrared Physics & Technology, 2012

Gastrointestinal Endoscopy, 2014

tablet application with an additional observer resulted in a 10.2% increase in the polyp detectio... more tablet application with an additional observer resulted in a 10.2% increase in the polyp detection rate, increasing the number of detected polyps by an average of 1.7 0.9 per procedure. Conclusions: Using the tablet software to increase the number of qualified participants is a valid approach to increasing the polyp detection rate for decreasing the incidence of colorectal cancer. The approach additionally allows for more effective medical training by enabling experienced physicians to more effectively highlight lesions and polyps using the endoscopic video. The proposed platform can be easily integrated into existing infrastructure for colonoscopy without interfering with the standard of care, and additionally be used for other types of endoscopy. Su1571 A Randomized Trial of Endoscopic Simulator Training in First Year Gastroenterology Fellows Pichamol Jirapinyo*, Vicki Bing, Nitin Kumar, Michele B. Ryan, Hiroyuki Aihara, Avlin B. Imaeda, Christopher C. Thompson Yale-New Haven Hospital, New Haven, CT; Division of Gastroenterology, Brigham & Women’s Hospital, Boston, MA Background: Training in endoscopy has traditionally relied upon clinical hands-on experience. Simulators may now allow the development of endoscopic skills in a non-clinical environment. Aim: To assess the effect of an endoscopic part-task simulator on trainees’ endoscopic performance. Methods: Simulator An endoscopic part-task training box consisting of 5 modules (snare polypectomy, retroflexion, torque, knob control and loop reduction/navigation) and a validated scoring system. Subjects: First year gastroenterology fellows from 2 academic institutions. Design: Fellows were randomized into 2 arms. The study arm practiced on the simulator for at least 45 minutes per week for the first 3 months of training, in addition to receiving traditional hands-on clinical training. The control arm received only hands-on clinical training. Outcomes: All fellows were assessed for their endoscopic skill performance using the Mayo Colonoscopy Skills Assessment Tool (MCSAT) and the simulator at month 0, 1 and 3. MCSAT scores, training box scores and the numbers of esophagoduodenoscopies (EGDs) and colonoscopies performed were collected. Statistical Analysis: Training box scores from the 2 arms were compared using a linear regression model adjusting for the numbers of EGDs and colonoscopies. Results: Ten first year gastroenterology fellows from 2 academic institutions participated in the study. Five were randomized into the study arm and 5 into the control arm. No participants had used the simulator prior to the study. Average numbers of prior EGDs and colonoscopies are shown in Table 1. There was no difference in total MCSAT hands-on skill scores between the 2 groups at month 1 (pO0.05), however, there was a trend for fellows in the simulator group taking less time (pZ0.09) to reach a farther landmark (hepatic flexure in simulator group vs. splenic flexure in control group (pZ0.22). Additionally, fellows in the study arm performed significantly better on the simulator at month 1 (Table 2; p!0.01), and showed significant improvement in training box performance from month 0 to month 1, compared to the control group (Table 2; p!0.05). At month 3, the control group eliminated this difference as reflected by similar MCSAT hands-on skill scores, time spent reaching the maximal insertion site, location of the farthest landmark reached without assistance and absolute simulator scores, compared to the simulator group (pO0.05 in all variables). Conclusion: The part-task endoscopic simulator provides a non-clinical environment for trainees to practice fundamental endoscopic maneuvers and become familiar with accessories prior to initiation of clinical cases, and during ongoing clinical training. This small sample size suggests that routine use of the simulator may improve technical endoscopic performance during the early phases of training, and larger studies are now needed. Table 1. Average numbers of esophagoduodenoscopies (EGDs) and colonoscopies (colons) performed www.giejournal.org Month 0 Month 1 Month 3 EGDs Colons EGDs Colons EGDs Colons Study arm (n [ 5) 4 4 31 21 62 38 Control arm (n [ 5) 4 1 24 20 51 25 Table 2. Average simulator scores

Gastrointestinal Endoscopy, 2014

Gastrointestinal Endoscopy, 2014

There is an urgent need to develop new and effective agents for cancer targeting. In this work, a... more There is an urgent need to develop new and effective agents for cancer targeting. In this work, a multivalent antibody is characterized in vivo in living animals. The antibody, termed ''trimerbody'', comprises a single-chain antibody (scFv) fragment connected to the N-terminal trimerization subdomain of collagen XVIII NC1 by a flexible linker. As indicated by computer graphic modeling, the trimerbody has a tripod-shaped structure with three highly flexible scFv heads radially outward oriented. Trimerbodies are trimeric in solution and exhibited multivalent binding, which provides them with at least a 100-fold increase in functional affinity than the monovalent scFv. Our results also demonstrate the feasibility of producing functional bispecific trimerbodies, which concurrently bind two different ligands. A trimerbody specific for the carcinoembryonic antigen (CEA), a classic tumor-associated antigen, showed efficient tumor targeting after systemic administration in mice bearing CEA-positive tumors. Importantly, a trimerbody that recognizes an angiogenesis-associated laminin epitope, showed excellent tumor localization in several cancer types, including fibrosarcomas and carcinomas. These results illustrate the potential of this new antibody format for imaging and therapeutic applications, and suggest that some laminin epitopes might be universal targets for cancer targeting.

Gastrointestinal Endoscopy, 2014

Gastrointestinal Endoscopy, 2014

Background-Larger gastrojejunal (GJ) anastomosis aperture is one independent predictor for weight... more Background-Larger gastrojejunal (GJ) anastomosis aperture is one independent predictor for weight regain after Roux-en-Y gastric bypass. Transoral outlet reduction (TORe) has proven safe and effective for treatment of weight regain by using a superficial-thickness (ST) suturing device. Full-thickness (FT) suturing devices are now available, potentially providing more effective results. Objective-To compare effectiveness of superficial-thickness with full-thickness TORe. Design-Matched cohort study: patients were matched sequentially by GJ anastomosis aperture, body mass index, and age. Setting-Tertiary-care center. Patients-A total of 59 consecutive patients undergoing full-thickness TORe were matched with 59 patients undergoing superficial-thickness TORe. All had GJ anastomosis apertures >20 mm. Intervention-Transoral outlet reduction. Main Outcome Measurements-Weight loss and rate of adverse events. Results-Post-TORe GJ anastomosis apertures were similar between groups (ST 6.9 ± 0.2 mm vs FT 7.1 ± 0.3 mm). Weight loss was greater at 6 months in the FT group (10.6 ± 1.8 kg in FT vs 4.4 ± 0.8 kg in ST; P < .01) and at 1 year (8.6 ± 2.5 kg in FT vs 2.9 ± 1.0 kg in ST; P < .01). Excess weight loss was greater in the FT group at 6 months (20.4 ± 3.3% in FT vs 8.1 ± 2.5% in ST; P < .01) and at 1 year (18.9 ± 5.4% in FT vs 9.1 ± 2.3% in ST; P = .03). Limitations-This was a single-center, retrospective, cohort study. Conclusion-There is level 1b evidence for effectiveness of TORe by using a superficial mucosal suturing device. This matched cohort study compared TORe by using the same ST suturing device with TORe by using a newer, FT suturing device and the same operative methods.

Gastrointestinal Endoscopy, 2013

incidentally diagnosed by an upper gastrointestinal endoscopy. All patients underwent Endoscopic ... more incidentally diagnosed by an upper gastrointestinal endoscopy. All patients underwent Endoscopic ultrasound to rule out deeper layers invasion. Lesions with ultrasonographic or endoscopic signs of lipomas were excluded. The size range was 1 to 4 cm in diameter. In 10 cases submucosal injection with saline serum and epinephrine was performed. Access to the submucosa was obtained using a needle knife to cut the mucosa and then the dissection was performed using a combination of blunt instruments: biopsy, foreign body or electrocoagulation forceps depending on each case. Once the resection was completed the edges were approached with endoscopic clips. In three patients under general anesthesia a tunel disection of the submucosa was performed removing the complete lesion. The remaining patients were made under propofol sedation. Results: All the lesions were completely resected without complications. Of the esophageal lesions, 3 were reported as leiomyomas, 4 GIST and 1 germinal cells tumor; the gastric lesions were reported as 2 lipomas, 3 GIST and 1 leiomyoma. Conclusion: The endoscopic blunt dissection and resection of subepitelial lesions in the esophagus and stomach is in trained hands; safe and efficient as long as the endoscopic ultrasound demonstrate integrity of the muscularis propria layer. The complete resection of the specimen in "one pice" allows the correct pathology report. It looks reasonable to combine different dissection techniques depending on the localization, size or any other particular characteristic in each case.