bluuebunny/crossref_metadata_2025_split huggingface dataset:
2935 Efficacy, Safety and Long-Term Follow-Up of a Single 7 Fr Double Pigtail Plastic Stent for EUS-Guided Pancreatic Pseudocyst Drainage
Authors: Rugivarodom Manus , Pausawasdi Nonthalee , Chantarojanasiri Tanyaporn , Chang Arunchai , Sirivatanauksorn Yongyut 
Published: October 2019

INTRODUCTION:
Endoscopic ultrasound (EUS) guided cystgastrostomy with placement of single or multiple 7 Fr or 10 Fr double-pigtail stent (DPS) is a standard treatment for symptomatic pancreatic pseudocyst (PP). However, using a single 7-Fr DPS is less popular in practice due to the concern of stent patency and adequacy of drainage. Aim: To assess the efficacy, complications and long-term outcomes of a single 7-Fr DPS in the drainage of uncomplicated PP with no detectable internal solid debris or infection.

METHODS:
Retrospective study of patients undergoing EUS-guided cystgastrostomy with a single 7-Fr DPS during 2010-2018.

RESULTS:
A total of 14 patients (9 males and 5 females) were identified. The mean age was 48.9 ± 12.5 years. 70% of pseudocysts were located in the pancreatic body; mean size of 10.2 cm (range, 5.5-16.0 cm). Abdominal pain was noted in 11/14 (79%) patients. The most common etiology was biliary pancreatitis (43%). Placement of a 7-Fr × 5 cm DPS had 100% technical success rate without significant complications. At 4 weeks follow-up, clinical success defined as complete resolution or ≥50% decrease in size of pseudocyst in association with resolution of symptoms was 100%. The status of pancreatic duct (PD) was assessed in 10/14 (71%) patients. Of these, 4/10 (40%) had PD leakage; 7/10 (70%) had complete PD disconnection. After a mean follow-up of 52 months (range, 10.1-102.8), pseudocysts resolved without recurrence or the need for additional procedures in 85% of patients. Eleven patients (64%) were noted to have spontaneous stent dislodgement at mean follow-up of 18.3 months (range 0.9-53.2). One patient with PD disruption developed stent migration into the cyst which required two additional sessions of EUS-guided drainage and underwent subsequent cystojejunostomy with stent removal. Another patient had infected cyst due to stent occlusion but she was treated successfully with EUS-guided drainage. Nonetheless, she underwent cystojejonostomy in the end given the presence of complete PD disruption and young age.

CONCLUSION:
This study demonstrated that treatment of true uncomplicated pseudocysts using a single 7 Fr DPS had an excellent technical and clinical success and respectable long term outcomes. True pseudocysts without internal solid debris are less common. Carefully selected pseudocysts may be effectively and safely treated with a single 7 Fr plastic stent.
2937 Endoscopic Ultrasound-Guided Drainage and Treatment of Symptomatic Walled-Off Pancreatic Necrosis: A Single Center Case Series
Authors: Rossow Brett , Hammoud Ghassan M. , Tahan Veysel , Ibdah Jamal A. , Mahdi Amin O. , Samiullah Sami , Romana Bhupinder 
Published: October 2019

INTRODUCTION:
Walled-off pancreatic necrosis (WOPN) develops within 4-6 weeks after acute necrotizing pancreatitis. Endoscopic transgastric pancreatic necrosectomy has emerged as a promising therapy for WOPN. We aim to evaluate the clinical success and outcomes of patients treated with endoscopic therapy for symptomatic WOPN.

METHODS:
Retrospective chart review of all patients who underwent endoscopic pancreatic necrosectomy from January 2015 until November 2018 was performed. Patients' demographics were obtained including etiology of pancreatitis, size of WON, number of endoscopic necrosectomies, time to resolution of necrosis, and outcome.

RESULTS:
15 patients underwent endoscopic necrosectomy for symptomatic WOPN. 60% were male, average age was 56 years. Etiologies of pancreatitis included: Biliary (46%), alcohol induced (20%), hypertriglyceridemia (13%), and idiopathic (20%). Nine (60%) cases presented with infected necrosis diagnosed by cross-sectional imaging and clinical criteria. The Median size of peripancreatic fluid collections was 14 cm (Range: 8-20 cm). Endoscopic necrosectomy was performed through the transgastric route in all patients. All patients underwent initial necrosectomy at time of cystgastrostomy. 13 (87%) patients had luminal apposing stents (LAS) (Axios, Boston Scientific). Axios 15 mm × 10 mm were most common. The mean number of endoscopic therapy sessions was 3.4 (Range 1-8). Two (13%) patients had migrated LAS within 4 weeks. One patient underwent repeat cystgastrostomy to remove an internal migrated stent. There were no reported complications of bleeding, procedure-related infection, or perforation associated with cystgastrostomy or necrosectomy. None of the patients suffered death. Clinical success was achieved in 80% of our patient population defined by resolution of fluid collection and necrosis and clinical improvement. 3 (20%) patients required additional surgical intervention. One required surgical intervention for a pancreatic fluid collection not accessible by the endoscope. One underwent surgery prior to presenting to our center. The third had a large sized necrosis with multiple admission for sepsis and failure to thrive.

CONCLUSION:
Sequential endoscopic transgastric necrostectomy is a promising therapy for WOPN and should be the first modality to treat patients with infected or symptomatic walled-off necrosis. Large fluid collections, recurrent admissions, failure to thrive, and collections not accessible by the endoscope were indicators for surgical intervention.
2943 Should We Stop Screening Patients With F3 Fibrosis for Esophageal Varices?
Authors: El-Halawany Hani , Zafar Yousaf , Galappaththy Suguni Loku , Nazer Marjan , Noman Anas , Chauhan Mahak , Al-Sayyed Leen 
Published: October 2019

INTRODUCTION:
Advanced liver fibrosis is an important predictor of liver disease progression and mortality, and current guidelines recommend screening for complications of cirrhosis once patients develop F3 fibrosis. Our study looked into patients with stage 3 (F3) fibrosis on liver biopsy and who had EGD subsequently for screening for varices.

METHODS:
We conducted a retrospective review of the patients who had a liver biopsy between 1/1/2017 to 10/1/2018 in our tertiary care institution. It was determined how many of the patients with F3 fibrosis underwent EGD and the results of those investigations are presented here. Furthermore, laboratory findings as well as risk factors for cirrhosis were analyzed among the patients with F3 fibrosis.

RESULTS:
A total of 18 patients were found who had a liver biopsy as part of work up for underlying liver pathology. All of the 18 patients had F3 stage fibrosis and underwent an EGD subsequently. None of these patients had any evidence of portal hypertension evidenced by varices. Only 44.4% (n = 8) of the patients had underlying transaminitis. All of them had normal serum creatinine and only 1 patient had underlying coagulopathy with an elevated INR of 1.9. Only 5 patients were actively drinking alcohol. None of these patients had underlying Hepatitis C or Hepatitis B infection.

CONCLUSION:
Our case series concludes that screening of F3 fibrosis may not be of any benefit for patients irrespective of the cause of their advanced fibrosis. Larger studies would be needed to prove this is the case as this study is limited by its retrospective nature and small number of subjects.
2945 Trend of NAFLD-Induced Cirrhosis and Mortality in National Population
Authors: Kirshan Ravi Shri Jai , Garg Rajat , Essrani Rajesh , Ravi Priyanika , Ahuja Satish Kumar , Ahuja Keerat Rai 
Published: October 2019

INTRODUCTION:
Non alcoholic Fatty liver disease (NAFLD) is one of the leading cause of chronic liver disease in United States. Combined with diabetes and metabolic syndrome, NAFLD is expected to be the most common cause of liver transplantation. We sought to determine the trend of NAFLD induced cirrhosis in National Population. We also studied the risk of decompensation and in hospital mortality in patients with NAFLD cirrhosis.

METHODS:
We obtained data from Nationwide Inpatient sample database using International classification of Diseases, the 9th revision, clinical modification codes to identify patients who had diagnosis of Cirrhosis and NAFLD from 2006-2014. We also obtained data on decompensation and patient's mortality in patients who had cirrhosis with history of NAFLD. Decompensated cirrhosis was defined as patients with cirrhosis and having one or more of these conditions: hepatic encephalopathy, hepatorenal syndrome, spontaneous bacterial peritonitis, ascites or variceal bleeding. Data was extrapolated using SPSS statistics software.

RESULTS:
Total of 4,226,236 patients had diagnosis of cirrhosis, 114,972 had NAFLD diagnosis. Trend of NAFLD is significantly increasing from 2007 (1.2%) to 2014 (3%). 2,313,524 (54.7%) of patients had decompensated cirrhosis. NAFLD was present in 3.2% (74,557) of patients in decompensated cirrhosis as compared to 2.1% (40,415) of patients who had compensated cirrhosis (P < 0.001). In hospital mortality of patients in decompensated cirrhosis with history of NAFLD was 4.3% and without history of NAFLD was 7.9% (P < 0.001). On Univariate analysis, patients with NAFLD were at low risk of in hospital death as compared to patients without NAFLD OR 0.53 (CI: 0.513–0.550).

CONCLUSION:
There has been significant increasing trend of NAFLD induced cirrhosis in last decade. NAFLD is associated with increased risk of cirrhosis decompensation as compared to other causes of cirrhosis. Interestingly, NAFLD cirrhotic patients have lower in hospital mortality as compared to patients with other causes of cirrhosis.
2949 Diagnostic Comparison of Magnetic Resonance and Endoscopic Retrograde Cholangiopancreatography in Post-Orthotopic Liver Transplant Patients
Authors: Rotundo Laura , Patel Pavan , Kutner Matthew , Ahlawat Sushil 
Published: October 2019

INTRODUCTION:
In post-liver transplant patients, biliary tract complications are one of the leading causes of morbidity, graft loss and mortality. Many patients with a cholestatic pattern of liver injury or findings of dilated ducts on imaging undergo magnetic resonance cholangiopancreatography (MRCP) as the initial test prior to definitive therapy. The gold standard for diagnosis and treatment is endoscopic retrograde cholangiopancreatography (ERCP). Currently, there are limited studies on the sensitivity and specificity of MRCP at diagnosing biliary complications. Our aim is to assess whether MRCP may prevent unnecessary invasive procedures or aid in the diagnosis of biliary complications.

METHODS:
This is a retrospective review of patients aged ≥18 years old who underwent a liver transplant at our tertiary level transplant center from January 2007 to December 2017. Of those post-transplant patients, individuals that had both an MRCP and ERCP performed for the same indication were selected. Reports were analyzed to assess for correlation between MRCP and ERCP findings. Other factors analyzed were age, sex, race, cause of prior end-stage liver disease, and liver enzyme levels.

RESULTS:
A total of 30 patients were included in this study. The mean age of patients was 56 years old with 73% being male. The most common indication for MRCP was abnormal liver function tests (LFTs), followed by transplant rejection (10%), fever (6.7%), abnormal imaging (3.3%), and abnormal biopsy findings (3.3%). Of these patients, 56.7% of MRCP findings correlated with ERCP findings. When divided among indication for MRCP, prior abnormal imaging (i.e., ultrasound or CT) was associated with the highest correlation (80%) between MRCP and ERCP. When an MRCP was performed due to abnormal LFTs, only 57.9% of cases correlated with ERCP findings. The sensitivity and specificity of MRCP in diagnosing biliary pathologies was 59% and 33%, respectively. In most cases, MRCP did not correlate with ERCP findings when it failed to detect an anastomotic stricture that was seen on ERCP.

CONCLUSION:
MRCP findings more closely correlated with ERCP findings when performed for abnormal prior imaging rather than for abnormal LFTs. Further studies are warranted to determine if MRCPs aid in the diagnosis of biliary disorders or delay time to definitive therapy via ERCP, as these findings suggest that cases of anastomotic strictures may go undiagnosed given the low sensitivity and specificity of MRCP.
2951 Patient Response to Ursodeoxycholic Acid (UDCA) in a Community Gastroenterology Practice
Authors: Mazzei Bonita A. , McKibbin Ralph D. 
Published: October 2019

INTRODUCTION:
The American Association for the Study of Liver Diseases (AASLD) has recently updated practice guidelines for the treatment of primary biliary cholangitis (PBC). Our practice treats patients in one of the recognized disease incidence “hot spots” where risk factors or natural history may be different from the national average. Located at the northern tip of the Appalachian region we have limited access to subspecialty hepatology services. Up to 40% of patients will have inadequate response to UDCA using guideline criteria. Obeticholic acid (OCA) has been approved to be used in combination with UDCA to treat inadequacy of response or as monotherapy in UDCA intolerant patients. We assessed adequacy of treatment to identify possible candidates for OCA therapy.

METHODS:
We searched our electronic medical records for all patients with ICD-9 code 571.6 and ICD-10 code K74.3 and reviewed charts for age, gender, date of diagnosis, anti-mitochondrial antibodies (AMA), alkaline phosphatase (ALP), liver biopsy, weight, UDCA dosage and OCA usage. We used ALP upper limit of normal ratio and mg per kg to calculate UDCA dosage and response. All diagnoses were confirmed with review of AMA results and liver biopsy.

RESULTS:
Seventy-seven patients were identified with 68 females, 9 males with age range of 28 to 88. The average duration of care was 7.2 years ranging from a few months to 24 years. Sixty-four patients are on UDCA. All patients are receiving UDCA in the recommended dosing range. Two patients were referred to transplant, 3 refused care due to relocation, 5 patients had their diagnosis changed and 6 were lost to follow up. Eight patients died with 76 as the average age of death. Five patients are currently on OCA. Three additional patients were identified as possible OCA candidates.

CONCLUSION:
Our patients are receiving recommended UDCA dosing however 12.5% of patients in our “hot spot” population (Gastroenterology and Endoscopy News 2016; 67:5:36) may be candidates for OCA therapy. Our review identified additional patients who could benefit from updated therapy guidelines.
2963 Changes in Health Behaviors Among Veterans With Chronic Hepatitis C Receiving Direct Acting Antiviral Therapy
Authors: Iqbal Sara , Parmer Rinkuben , Burton Mary 
Published: October 2019

INTRODUCTION:
Persons infected with hepatitis C virus (HCV) are more likely to use tobacco, consume larger quantities of alcohol, and use recreational cannabis as those without HCV infection. A recent multi-center study suggested that interferon-based treatment for HCV encouraged reduction in consumption of tobacco, alcohol and cannabis. Because direct acting antivirals (DAAs) require a shorter period of treatment, the same effect on lifestyle change may not be present. The purpose of this study was to evaluate changes in tobacco, alcohol and cannabis use in Veterans on HCV DAAs.

METHODS:
Veterans initiating HCV treatment with DAAs at the G V Sonny Montgomery VAMC were offered study enrollment. After providing written informed consent, veterans completed a survey of demographic information and current/past tobacco, alcohol and illicit drug use. Follow up visits occurred at weeks 4, 8 and 12 of treatment. Veterans self-reported on tobacco, alcohol or illicit drug use in the past 4 weeks. Data was analyzed using SPSS v.23. The G.V. Sonny Montgomery Institutional Review Board approved this study.

RESULTS:
Thirty veterans were enrolled between May 1, 2013 and Dec 31, 2014. Majority of patients were male (n = 26) and Caucasian (n = 17). The major infecting genotype was 1a (n = 13), followed by 1b (n = 9), 1 undifferentiated (n = 5) and 2b (n = 3). At baseline, 47% reported current tobacco use, 20% reported current alcohol use and 10% reported current cannabis use. At week 12, reported tobacco use decreased to 43% (P = 1.0), alcohol use decreased to 11% (P = 1.0) and marijuana decreased to 4% (P = 0.5).

CONCLUSION:
Limitations to our study include small sample size, self-reported data and lack of control group. There was however decreasing trend of tobacco, alcohol and cannabis use with the only intervention being initiation of direct acting antivirals for hepatitis C. We propose that HCV DAAs may represent an opportunity to promote healthy lifestyle changes for Veterans.
2981 Identifying Adventurous Eating Children: Associations With Sociodemographic Characteristics, Eating Behaviors, and Weight Gain
Authors: Afzal Soha , Appugliese Danielle , Miller Alison , Lumeng Julie , Pesch Megan 
Published: October 2019

INTRODUCTION:
Adventurous eating in adulthood has been associated with increased dietary variety and healthy body mass index, however little is known about correlates of adventurous eating in children.

METHODS:
Data were collected at three time points: Baseline (age 4 years), Time point 1 (age 6 years), Time point 2 (age 8 years). At each time point mothers completed questionnaires and anthropometrics were measured. At baseline and Time point 1, children participated in observational eating tasks. Statistical analysis was done using cluster analysis.

RESULTS:
Two clusters were identified: Adventurous eaters and Non-adventurous eaters. Being an adventurous (vs. non) eater at time point 1 was correlated with greater child surgency, dietary variety, ability to delay gratification and maternal pressure to eat. Being an adventurous (vs. non) eater was associated with greater maternal restriction at time point 1. Adventurous eating was not associated with child body mass index z-score, or prospective weight gain.

CONCLUSION:
Adventurous eating is correlated with child temperamental traits that are associated with seeking novel experiences. There also may be maternal influence on child adventurous eating. Adventurous eating was not associated with cross-sectional or prospective body mass index z-score.
2982 Gastroenterology Journal Prestige and Impact: Analysis of Journal Rankings
Authors: Zafar Yousaf , Gondi Keerthi , Luke Alex 
Published: October 2019

INTRODUCTION:
Scientific research is critical to the progression of the field of gastroenterology. Journals are given impact factor ratings annually to determine the utilization and citation of their published articles. The rankings of gastroenterology journals have not been investigated.

METHODS:
We conducted a retrospective study of gastroenterology journals from 2010 to 2017. Ranking scores from the SCImago Journal Rank (SJR) indicator, a composite score of impact factor, prestige, and closeness of citing articles. The top twenty journals in gastroenterology and hepatology were included and compared to the top ten journals in cardiovascular disease, general internal medicine, and general surgery.

RESULTS:
The number of gastroenterology journals increased from 134 to 143 in this time period. The top ten journals were Gastroenterology, Gut, Journal of Hepatology, American Journal of Gastroenterology, Alimentary Pharmacology & Therapeutics, Liver Cancer, Natural Clinical Practice Gastroenterology, Clinical Gastroenterology & Hepatology, and Journal Crohn’s and Colitis. Gastroenterology rankings increased from an average of 2.61 to 4.82 (185% increase), compared to a 322% increase and 254% increase in cardiovascular disease and general internal medicine, respectively. The percentage increase per year was significantly lower than similar increase in cardiovascular disease and general internal medicine journals (P < 0.05 for all years).

CONCLUSION:
Gastroenterology journals lag in citation and prestige compared to other major internal medicine fields. The reasons for this diminished impact should be investigated, and journals should explore mechanisms to disseminate research effectively and improve outreach.
2985 Low Diagnostic Yield of Routine Duodenal Biopsies in Asymptomatic Patients With Iron Deficiency Anemia
Authors: Kwon Alvin Guyun , Yoo Heesoo , Nam Myungwoo , Barsky Maria , Nguyen Nghia , Kalmaz Denise 
Published: October 2019

INTRODUCTION:
It is estimated that 1.6 billion people worldwide are anemic. Iron deficiency anemia (IDA) is the most common form of anemia worldwide. In adults without an obvious source of blood loss, the explanation for IDA is generally thought to be due to chronic gastrointestinal blood loss. Current guidelines recommend performing both upper and lower endoscopies for patients with iron deficiency anemia. Duodenal biopsies are routinely performed to evaluate for celiac sprue as the etiology of IDA. The primary aim of this study is to determine the diagnostic yield of routine duodenal biopsies performed for investigation of asymptomatic patients with iron deficiency anemia (without malabsorption symptoms).

METHODS:
A retrospective chart review was performed of patients undergoing esophagogastroduodenoscopy (EGD) with duodenal biopsy as work up of IDA. All duodenal biopsies were performed from January 2011 through April 2019 at an academic tertiary referral center. Inclusion criteria was ferritin ≤45 ng/mL within 1 year prior to EGD. If ferritin data was unavailable, physician records were reviewed for diagnosis of iron deficiency anemia in patients who had proven serum MCV < 80 um3 within 1 year prior to EGD. Data was collected for asymptomatic patients, N = 250. Charts were reviewed and patients with malabsorption symptoms such as abdominal pain, weight loss, diarrhea, and bloating were excluded. In addition, patients with rectal bleeding, history of IBD, gastrointestinal cancer, lymphoma or abdominal surgery leading to malabsorption were also excluded. A diagnosis of celiac disease was defined as a Marsh type 2 or greater on tissue biopsy.

RESULTS:
The median age of patients was 60.6 ± 14.1 of whom 43% were female. A total of 59% of cases were Caucasian, 19% were Hispanic, 8% African American, 8% Asian and 9% other. The mean of Hgb was 9.2 ± 1.9 gm/dL, MCV, 76.4 ± 8.0% and ferritin, 21.7 ± 38.7 um3. Of the sample, 25% had DM2, 20% had CAD, 14% had CKD, 12% had atrial fibrillation and 6% had cirrhosis. The overall diagnostic yield of the duodenal biopsies was 0.4% in asymptomatic patients.

CONCLUSION:
These results suggest that performing routine duodenal biopsies for celiac disease in patients with IDA is low yield in asymptomatic patients. Further studies are needed to characterize which patients with IDA would benefit from a duodenal biopsy for diagnosis of celiac disease.