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- 저자 : Amy Tyberg (검색결과 4 건)
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Amy Tyberg,Jose Nieto,Sanjay Salgado,Kristen Weaver,Prashant Kedia,Reem Z. Sharaiha,Monica Gaidhane,Michel Kahaleh 대한소화기내시경학회 2017 Clinical Endoscopy Vol.50 No.2
Background/Aims: Performing endoscopic retrograde cholangiopancreatography (ERCP) in patients who have undergone Roux-en-Y gastric bypass (RYGB) is challenging. Standard ERCP and enteroscopy-assisted ERCP are associated with limited success rates. Laparoscopy- or laparotomy-assisted ERCP yields improved efficacy rates, but with higher complication rates and costs. We present the first multicenter experience regarding the efficacy and safety of endoscopic ultrasound (EUS)-directed transgastric ERCP (EDGE) or EUS. Methods: All patients who underwent EDGE at two academic centers were included. Clinical success was defined as successful ERCP and/or EUS through the use of lumen-apposing metal stents (LAMS). Adverse events related to EDGE were separated from ERCP- or EUS-related complications and were defined as bleeding, stent migration, perforation, and infection. Results: Sixteen patients were included in the study. Technical success was 100%. Clinical success was 90% (n=10); five patients were awaiting maturation of the fistula tract prior to ERCP or EUS, and one patient had an aborted ERCP due to perforation. One perforation occurred, which was managed endoscopically. Three patients experienced stent dislodgement; all stents were successfully repositioned or bridged with a second stent. Ten patients (62.5%) had their LAMS removed. The average weight change from LAMS insertion to removal was negative 2.85 kg. Conclusions: EDGE is an effective, minimally invasive, single-team solution to the difficulties associated with ERCP in patients with RYGB.
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The Learning Curve for Peroral Endoscopic Myotomy in Latin America: A Slide to the Right?
Michel Kahaleh,Amy Tyberg,Supriya Suresh,Arnon Lambroza,Fernando Rodriguez Casas,Mario Rey,Jose Nieto,Guadalupe Ma Martínez,Felipe Zamarripa,Vitor Arantes,Maria G Porfilio,Monica Gaidhane,Pietro Fami 대한소화기내시경학회 2021 Clinical Endoscopy Vol.54 No.5
Background/Aims: Peroral endoscopic myotomy (POEM) has been increasingly used for achalasia in Latin America, where Chagasdisease is prevalent, and this makes POEM more challenging. The aim of this study was to determine the learning curve for POEMin Latin America. Methods: Patients undergoing POEM in Latin America with a single operator were included from a prospective registry over 4 years. Non-linear regression and cumulative sum control chart (CUSUM) analyses were conducted for the learning curve. Results: A total of 125 patients were included (52% male; mean age, 59 years), of which 80 had type II achalasia (64%), and 38 hadChagas disease (30%). The average pre-procedure and post-procedure Eckardt scores were 6.79 and 1.87, respectively. Technicalsuccess was achieved in 93.5% of patients, and clinical success was achieved in 88.8%. Adverse events occurred in 27 patients (22%)and included bleeding (4 patients), pneumothorax (4 patients), mucosal perforation (13 patients), mediastinitis (2 patients), andleakage (4 patients). The CUSUM chart showed a median procedure time of 97 min (range, 45-196 min), which was achieved at the 61st procedure. Procedure duration progressively decreased, with the last 10 procedures under 50 min approaching a plateau (p-value <0.01). Conclusions: Mastering POEM in Latin America requires approximately 61 procedures for both POEM efficiency and to accomplishthe procedure within 97 minutes.
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Ming-ming Xu,Enad Dawod,Monica Gaidhane,Amy Tyberg,Michel Kahaleh 대한소화기내시경학회 2020 Clinical Endoscopy Vol.53 No.1
Superior mesenteric artery syndrome (SMAS) causes compression and partial or complete obstruction of the duodenum, resulting inabdominal pain, nausea, vomiting, and weight loss. If conservative therapy fails, the patient is typically referred for enteral feeding orlaparoscopic gastrojejunostomy. The last few years have seen increasing use of endoscopic ultrasound-guided gastrojejunostomy (EUS-GJ) for gastric obstructionindications. EUS-GJ involves the creation of a gastric bypass via an echoendoscope in cases in which the small intestine can bepunctured under ultrasonographic visualization, resulting in an incision-free, effcient, and safe procedure. In this case report, we present the first case of SMAS treated using a reverse EUS-GJ, and describe the steps and advantages of theprocedure in this particular case.
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Ming Ming Xu,Iman Andalib,Aleksey Novikov,Enad Dawod,Moamen Gabr,Monica Gaidhane,Amy Tyberg,Michel Kahaleh 대한소화기내시경학회 2020 Clinical Endoscopy Vol.53 No.3
Background/Aims: Endoscopic ultrasonography (EUS)-guided drainage is the preferred approach for infected or symptomaticpancreatic fluid collections (PFCs). Here, we developed an algorithm for the management of pancreatitis complicated by PFCs andreport on its effcacy and safety. Methods: Between September 2011 and October 2017, patients were prospectively managed according to the algorithm. PFCs wereclassified as poorly organized fluid collections (POFCs), pancreatic pseudocysts (PPs), or walled-off pancreatic necrosis (WOPN). Clinical success was defined as a decrease in PFC size by ≥50% of the maximal diameter or to ≤2 cm. Results: A total of 108 patients (62% male; mean age, 53 years) were included: 13 had POFCs, 43 had PPs, and 52 had WOPN. Seventytwopatients (66%) required a pancreatic duct (PD) stent, whereas 65 (60%) received enteral feeding. A total of 103 (95%) patientsachieved clinical success. Eight patients experienced complications including bleeding (n=6) and surgical intervention (n=2). Patientswith enteral feeding were 3.4 times more likely to achieve resolution within 60 days (p=0.0421), whereas those with PD stenting was fivetimes more likely to achieve resolution within 90 days (p=0.0069). Conclusions: A high PFC resolution rate can be achieved when a dedicated algorithm encompassing EUS-guided drainage, PDstenting, and early enteral feeding is adopted.
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