bluuebunny/crossref_metadata_2025_split huggingface dataset:
2791 Metastatic Lesions to the Pancreas: A Tertiary EUS Center Experience
Authors: Xie Chencheng , Abdallah Mohamed , Patel Bhaveshkumar , Bohy Kimberlee , Aloreidi Khalil , Abdullah Hafez Mohammad A. , Sudhagoni Ramu , Kiani Rabia , Atiq Muslim 
Published: October 2019

INTRODUCTION:
Metastatic lesions of the pancreas present with varying clinical features and biological behaviors. They account for approximately 2% of all pancreatic lesions. This study was conducted to investigate metastatic pancreatic lesions distinctive clinical and EUS features compared to primary solid pancreatic neoplasms.

METHODS:
Patients who underwent EUS-FNA at a tertiary referral center between July 15th, 2011 and November 30th, 2017 for a solid pancreatic neoplasm were identified. Data on clinical features, cross-sectional imaging findings, EUS findings, and cytology results were collected. The clinical and EUS features in patients with metastatic pancreatic lesions were compared with those with intrinsic solid pancreatic tumors (adenocarcinoma and neuroendocrine tumors).

RESULTS:
8 patients who underwent 9 EUS-FNA procedures were diagnosed with a metastatic pancreatic lesion while 184 cases of solid primary pancreatic neoplasms (157 adenocarcinomas and 27 neuroendocrine tumors) were found. 5 of 8 metastatic pancreatic lesions were renal cell carcinoma (62.5%). Patients in the metastatic pancreatic lesions group were less likely to present with abdominal pain (33.3% vs. 71.7%, P = 0.014). Patients with metastatic pancreatic lesions also had lower CA 19-9 values (mean value: 82.50 U/mL vs. 4374 U/mL) and more frequently manifested as having multiple pancreatic locations involvement (55.6% vs. 4.9%).

CONCLUSION:
The most common metastatic pancreatic lesion is renal cell carcinoma. The clinical manifestation of metastatic pancreatic lesion patients is more insidious and is mostly identified by using surveillance imaging to identify the primary malignancy. A high index of clinical suspicion is needed for diagnosing these cases.
2799 The Association of Pancreato-Biliary Cancer With Lactose Intolerance
Authors: Asfari Mohammad Maysara , Sarmini Muhammad Talal , Sharjeel Arshad Hafiz Muhammad , Uy Pearl Princess , Kendrick Katherine , Hudgi Amit , Sifuentes Humberto , Sridhar Subbaramiah 
Published: October 2019

INTRODUCTION:
The association of lactose intolerance (LI) with different malignancies including ovarian, prostate and colon cancers are reported in the literature with different hypotheses. Many components of dairy foods have been shown experimentally to carry protective effects against colon cancer. On the other hand, the hydrolyzing product of the milk sugar lactose has been suggested to be a risk factor for ovarian carcinoma. We aimed in our study to investigate the association of LI with pancreatic cancer (PC) and cholangiocarcinoma (ChC) using a large database.

METHODS:
We performed a cross sectional study using the National Inpatient Sample (NIS) database between 2004 and 2014. We identified adult patients (18-90 years) who were diagnosed with LI (study group) using appropriate ICD-9 codes. The control group was the patients who did not have a diagnosis of LI. We identified the diagnosis of PC and ChC in both study and control groups using the ICD-9 codes. Univariable and multivariable logistic regression analysis were performed to assess the association between LI, PC and ChC.

RESULTS:
The total population was comprised of 71,360,501 patients, of which 57,909 (0.08%) were diagnosed with LI. LI patients were older (62 vs 51) with more females (61.5% vs 60.1%) and less African American patients (11.8% vs 14.8%) (P < 0.0001 for all). In addition, LI patients had more smoking (12.4% vs 12%), obesity (15% vs 8.9%) and inflammatory bowel disease (2.2% vs 0.8%) (P < 0.002). On the other hand, LI had less alcohol use (4.2% vs 3.8%) and diabetes mellitus (DM) (1.6% vs 4%) (P < 0.0001 for all). After adjusting for the age, gender, race, smoking, alcohol, obesity and inflammatory bowel disease the association between LI and PC were not statically significant (OR: 1.068, 95% CI, 0.909-1.048, P = 0.486). The same results were found for the association of LI and ChC (OR:0.855, 95% CI, 0.558-1.312, P = 0.474).

CONCLUSION:
There is no statically significant association between lactose intolerance, pancreatic cancer or cholangiocarcinoma.
2803 Obesity Among Pancreatic Cancer Patients: A Trend Analysis of 15 Years
Authors: Twohig Patrick , Butt Muhammad , Gardner Timothy , Sandhu Sonia , Sandhu Dalbir S. 
Published: October 2019

INTRODUCTION:
Global rates of obesity are increasing exponentially. The risk of developing pancreatic cancer has been shown to be significantly higher in obese patients. Additionally, the progression and outcome of malignancy has been shown to be worse in obese patients. Pancreatic cancer is the seventh leading cause of cancer-related deaths worldwide, with a 5-year survival rate of only 9%. Limited data exists on the demographic trends of obesity in pancreatic cancer patients. Our aim is to characterize trends in obesity among pancreatic cancer patients over the last 15 years.

METHODS:
We performed a retrospective analysis of patients in the IBM Explorys database (1999-2018), a pooled, de-identified clinical database of unique patient records from 26 health care networks and 300 hospitals across the United States. At the time of analysis there were 63,744,040 patients, of which 9,620 were adults ( >18 years old) with both pancreatic cancer and obesity (BMI > 30). Patient populations were identified using SNOMED and ICD codes. Cochrane-Armitage testing was performed to analyze trends in obesity among pancreatic cancer patients between 2004-2018. Subgroup analysis for insurance status and mortality rate were assessed.

RESULTS:
The percentage of obese patients with pancreatic cancer increased over the 15-year period (2.5% to 8.5%; P < 0.0001). Mortality rates in obese patients increased (2.4% to 7.4%; P = 0.00007). Rates of obesity among pancreatic cancer patients increased among all types of insurance, but most significantly in those with private insurance (P = 0.00008) and Medicare (P = 0.0001).

CONCLUSION:
This is the first study to assess trends in obesity among pancreatic cancer patients over the last 15 years. Obesity increases pancreatic cancer risk by increasing inflammation, intestinal bacterial overgrowth, and hormonal imbalance. Trials have demonstrated that inhibiting inflammation may delay tumor onset and decrease tumor size, providing an important future therapeutic target. Bariatric surgery can create up to a 60% reduction in pancreatic cancer incidence over a 10-year period, suggesting that weight loss could also be an effective preventative measure in these patients. Public health and epidemiologic data suggest that obesity will continue to significantly increase the incidence of pancreatic cancer. Developing methods to combat obesity and increase public awareness of the risks of obesity and cancer are of utmost importance.
2804 Outcomes in Intra-Ductal Papillary Mucinous Neoplasms in the New York Harbor Veteran Population: An Update
Authors: Hossain Naseem , Horowitz Judah , Grunwald Matthew , Martinez Manuel , Frank David M. 
Published: October 2019

INTRODUCTION:
Over the last few years there has been an increase in the frequency of findings of intra-ductal papillary mucinous neoplasms (IPMNs). This is likely due to the increased use of advanced abdominal imaging as well as in increase in the quality of these images. In most cases, decisions are based on consensus rather than evidence based as to how to proceed with regard to follow up imaging, biopsy, or even surgical resection. At ACG 2017, we presented the outcomes of and natural history of patients with IPMNs in the Brooklyn VA. Since that presentation, we have an update regarding further data points as well as in increase in the number of patients we analyzed.

METHODS:
Retrospective chart review was performed on patients with diagnosis, based on coding) of pancreatic cyst, pancreatic lesion, and intra-ductal pancreatic mucinous neoplasm from the New York Harbor Veterans Affairs Hospital from 2000 to 2015. 767 patients were initially flagged, and based on either radiology reports or clinic notes 104 were determined to actually have an IPMN. We looked at basic demographics, risk factors and survival data.

RESULTS:
Baseline characteristics are outlined in Table 1 of the 104 patients formally diagnosed with an IPMN. In summary, 101 are male. The average age at the time of initial diagnosis was 71.5 years old, the median age was 72 years old. The average Body Mass index was 27.3. The subjects in this study were overwhelmingly African American (40.6%) and White (42.6%). There was a small Hispanic component (14.6%). There were no Asian patients in the study. Nine patients underwent surgical resection. 33 patients died and the median time to survival was not able to be calculated at this time. The average age at the time of death was 78.9 years old. In the 33 patients that died only 6 Patients (5.7% of total patients diagnosed) died from pancreatic causes.

CONCLUSION:
The management of IPMNs presents a clinical challenge for gastroenterologists today. To date, the levels of evidence in which the current guidelines are based on is poor. Our study is limited by factors such as advanced age, gender and multiple comorbidities preventing further invasive interventions. It is due to these factors, that our study is not applicable to the general population. Therefore, we recommend further larger multicenter trials with a diverse cohort to establish the risk of IPMN’s and their effect on mortality from pancreatic cancer.
2807 Endoscopic Management of Tumors of Minor Ampulla: A Multicenter Case Series
Authors: Aslam Rida , Ahsan Nayab , Ayub Kamran 
Published: October 2019

INTRODUCTION:
Ampullary and duodenal carcinoma are aggressive cancers with poor 5 year survival rates. Like colorectal cancer, ampullary and duodenal carcinomas are also thought to follow the adenoma-carcinoma sequence. Ampullectomy is a well-established treatment for early stage carcinoma of major ampulla. Several studies have established its safety and efficacy in the management of major ampullary tumor. However, tumors arising in the minor ampulla are relatively rare and there are no good case series on endoscopic management of these tumors. We report a multicenter case series of endoscopic ampullectomy in the management of minor ampullary tumors.

METHODS:
To establish the safety and efficacy of endoscopic ampullectomy in the management of minor ampullary tumors. Consecutive patients undergoing ampullectomy for minor ampullary tumor at four hospitals were included in this study over a period of 5 years. A total of 6 patients were included in the study and all six patients underwent ERCP for purpose of minor ampullectomy. MRCP and EUS was performed on all patients prior to ERCP to rule out invasion. Pancreatic stents were placed after ampullectomy in 5 patients.

RESULTS:
Ampullectomy was technically successful in all 6 patients. One patient required two ERCPs for complete ampullectomy. The tumors varied in size from 1 cm to 3 cm. Pathology revealed adenoma in three patients, adenoma with high grade dysplasia in one patient, carcinoma in one patient, and carcinoid tumor in one patient. One patient (16%) developed post ERCP pancreatitis; this patient was kept in the hospital for 2 days. No other major complications were noted. Follow-up for these patients ranged from 2 to 5 years with EGD using duodenoscope at 3 months, one year and yearly thereafter. One patient had recurrence at 2 years which was thought to be recurrent tumor (4 mm). This patient was treated with repeat ampullectomy.

CONCLUSION:
This study demonstrates the safety and efficacy of endoscopic removal of minor ampullary tumors. Our case-series showed a comparable rate of procedure-related complication of (16.6%), as one out of six patients was found to have pancreatitis. The other 5 patients had no complications and were discharged within 24 hours. Among the patients who followed up, there were no recurrences of tumor and no patient was found to have cancer develop over a mean follow-up period of 2 to 5 years. This demonstrates that complete removal of these lesions via endoscopic resection is safe and has favorable outcomes.
2811 Outcomes of Endoscopic Ultrasonography (EUS) in Patients Referred for Biliary Dilation Without Significant Biochemical Cholestasis
Authors: Able Kelsey L. , Madhoun Mohammad , Hanafi Muhammad Z. , Hayat Maham , Bitar Hussein , Howard Trenton , Tierney William , Maple John 
Published: October 2019

INTRODUCTION:
The diagnostic yield of endoscopic ultrasound (EUS) in non-jaundiced patients with unexplained biliary dilation has been reported to be 6-33%. In our experience, patients with unexplained biliary dilation who use chronic narcotic analgesics might have an even lower diagnostic yield at EUS. However, this correlation has not been well-described as yet.

METHODS:
We reviewed electronic medical records of patients referred to our center for EUS for the primary indication of unexplained biliary dilation between July 2007 and June 2017. Our database search yielded 767 potential subjects. Exclusion criteria included pancreaticobiliary masses, stones, or calcific chronic pancreatitis seen on prior imaging, a total serum bilirubin >3 mg/dl, or alkaline phosphatase (AP) > 1.5x the upper limit of normal. Data were also separately abstracted on patients with liver tests exceeding the above criteria, yet who had no other exclusion criteria.

RESULTS:
41 patients met all inclusion and exclusion criteria. The mean age was 62.4 ± 14.5 years, 37 (90.2%) were female, the mean bile duct diameter at EUS was 12.2 ± 3.8 mm, total bilirubin was 0.6 ± 0.3 mg/dL and AP was 112 ± 62.9 U/L. Most patients (33/41, 80.5%) were symptomatic, reporting abdominal pain or weight loss. A majority (29/41, 70.7%) of patients used oral narcotics. EUS demonstrated choledocholithiasis in 3/29 patients (10.3%) using narcotics and 1/12 (8.3%) not using narcotics. No masses or other relevant pathology was observed. This patient cohort was then combined with 39 additional patients with unexplained biliary dilation who had abnormal liver biochemical tests. Multivariable logistic regression analysis revealed that patients with abnormal liver biochemical tests were 3 times more likely to have positive EUS finding (OR 2.9, CI [1.5,5.7], P = 0.002). Patients using chronic narcotic analgesics were less likely to have positive EUS finding (OR 0.3, CI [0.1, 1.1], P = 0.06).

CONCLUSION:
A majority of patients referred for EUS to investigate biliary dilation without biochemical cholestasis were women using chronic narcotic analgesics. The diagnostic yield of EUS in this population was low (9.8%) and no neoplasia was found. In contrast, the yield of EUS in patients with biliary dilation and elevated liver tests was strikingly higher at 85%. Use of chronic narcotic analgesics appeared to predict a reassuring EUS examination.
2819 The Role of Prophylactic Antibiotics in Peritoneal Dialysis Patients Undergoing Colonoscopy: A Systematic Review and Meta-Analysis
Authors: Jayaraj Mahendran , Mohan Babu P. , Makar Ranjit , Ohri Ritika , Lankarani Daisy S. , Ohning Gordon 
Published: October 2019

INTRODUCTION:
End stage renal disease patients on peritoneal dialysis (PD) are at risk of peritonitis due to possible bacterial translocation from the colon during preparation for colonoscopy or during performing colonoscopy. ASGE guidelines and ISPD (International Society for Peritoneal Dialysis) guidelines suggest antibiotic prophylaxis while European Society of Gastroenterology does not give a clear guideline in this regard. ASGE guidelines in this regard is based on weak evidence. We attempted to conduct a systematic literature review and a meta-analysis to provide more evidence in this area.

METHODS:
A systematic search of PubMed, Medline, Web of Science, and Google Scholar through April 2019 using PRISMA and MOOSE guidelines identified 3 studies that reported on the occurrence of peritonitis during colonoscopy in patients on peritoneal dialysis. Case reports were excluded. Only prospective and retrospective large series studies were included. Random-effects pooled odds ratio and 95% confidence intervals were estimated. Heterogeneity was measured by Cochrane Q and I2 statistics.

RESULTS:
A total of 3 studies reporting on 216 colonoscopy procedures performed on patients undergoing peritoneal dialysis were included in the final analysis. The mean age ranged from 44 to 64 years. The pooled Odd's ratio of developing peritonitis while on antibiotics during colonoscopy was 0.68 (95% 0.19-2.4, I2 = 0, P = 0.56). This was not statistically significant. No heterogeneity was noted in the analysis.

CONCLUSION:
Based on our study, the administration of antibiotics does not seem to affect the incidence of peritonitis in PD patients undergoing colonoscopy. However, this is based on very limited number of studies and unequal sample-size in comparison groups. We, therefore, cannot recommend or refute the usage of prophylactic antibiotics in PD patients undergoing colonoscopy. This analysis shows the paucity of data available at this time in this regard. More robust studies with similar comparison groups are warranted to guide decision making.
2820 A Retrospective Study to Assess Safety and Efficacy of the HET Bipolar Ligator System for the Treatment of Grade I and II Internal Hemorrhoids
Authors: Malik Fahad , Herrero Laura N. , Vadada Deepak , Deshpande Vrushak 
Published: October 2019

INTRODUCTION:
Hemorrhoidal disease is a common condition, affecting about 80% of all Americans at some point in their life. There are two types of hemorrhoids: internal and external hemorrhoids. The internal hemorrhoids are further classified into four grades depending on their presentation. The HETTM Bipolar Ligator System is a nonsurgical safe and easy procedure that uses sterile, single-use bipolar forceps with a tapered tubular configuration for the treatment internal hemorrhoids. This study evaluated the efficacy and safety of the HETTM Bipolar Ligator System for the treatment of grade I and grade II hemorrhoids with the potential idea to improve overall patient care.

METHODS:
Primary goal was to evaluate the efficacy and safety of the HETTM Bipolar Ligator System for the treatment of grade I and grade II hemorrhoids. Using a chart review, all of the patients who had received elective treatment for grade I or grade II internal hemorrhoids with the HETTM Bipolar Ligator System from April 2013 to November 2016 in our community hospital. A total of 100 patients were studied for treatment with the HETTMsystem.

RESULTS:
Total of 100 patients received treatment with the HETTM system, 39 patients were male, and 61 were female. The mean age of the patients was 59 years. 27% of the patients complained of mild bleeding, 49% of moderate bleeding and 24% of severe bleeding. 31% of the patients complained of daily bleeding, 53% complained of bleeding at least once a week and 16% complained of bleeding less than once a week. 37% of patients had grade I hemorrhoids while 63% had grade II hemorrhoids. Only 11% of the patients reported pain at levels 1–2 (out of 5) immediately after the procedure, and in 15% of the patients, mild bleeding was observed. After the six-month follow-up period (Figure 3), 96% of the patients had a resolution of bleeding (primary goal). Lastly, all of the patients reported a high level of satisfaction with the procedure.

CONCLUSION:
All other hemorrhoidal treatments including rubber band ligation, sclerotherapy, bipolar diathermy, cryotherapy and laser photocoagulation were associated with complications such as postoperative pain and bleeding or required multiple treatments to provide relief. The HETTM ligation device is a novel treatment option for symptomatic grade I and grade II hemorrhoids. It is simple, cost effective, safe and highly effective in resolving bleeding hemorrhoids in a single non-surgical ambulatory setting.
2821 Trends and In-Hospital Outcomes in Gastrointestinal Malignancies: A National Perspective
Authors: Elkhattib Ismail , Desai Aakash , Noor Arish , Delasos Lukas 
Published: October 2019

INTRODUCTION:
There is limited evidence available regarding the trends of hospitalization and in-hospital outcomes amongst various gastrointestinal malignancies. Our study measured the trends of hospitalization and the difference related to in-hospital outcomes, such as inpatient length of stay (LOS), cost and mortality in patients with various gastrointestinal malignancies.

METHODS:
The National Inpatient Sample (NIS) dataset was queried from 2009 to 2014 to identify all patients with a multilevel diagnosis of gastrointestinal neoplasms including cancer of the esophagus, cancer of the stomach, cancer of the colon, cancer of rectum/anus, cancer of the liver and intrahepatic bile duct and cancer of the pancreas. Categorical and continuous variables were tested using Chi-square test and Student t-test respectively.

RESULTS:
We identified a total of 1,995,281 patients with a diagnosis of neoplasm from 2009 to 2014. Among them, 15,276 (0.8%) had cancer of the esophagus, 28,018 (1.4%) had cancer of the stomach, 114,917 (5.8%) had cancer of the colon, 49,690 (2.5%) had cancer of the rectum and anus, 26,565 (1.3%) had cancer of liver and intrahepatic bile duct, 44,749 (2.2%) had cancer of the pancreas. We found that colon cancer had the highest inpatient mortality rate of 5.8% while esophageal cancer had the lowest at 0.8%. The mean LOS for cancer of the stomach was the longest (≈9.49 days) while the cost of care was highest for esophageal cancers (26752.84$). More importantly, the trend of hospitalization among all the major subtypes of gastrointestinal malignancies was significantly unchanged over the period of 5 years.

CONCLUSION:
Gastrointestinal malignancies in the United States represent a significant burden of disease. Our study provides further evidence that there is a significant burden of cost, hospitalization, as well as mortality in this cohort of patients. Given the alarming increase in the incidence of gastrointestinal malignancies and related deaths, such data may have profound implications regarding future demographics to focus research, screening or preventative measures accordingly.