Papers by Laurence Stawick
PubMed, Jun 1, 2013
Aim: Double balloon enteroscopy (DBE) has been extensively used in tertiary referral centers but ... more Aim: Double balloon enteroscopy (DBE) has been extensively used in tertiary referral centers but little literature exists on the efficacy, complications and outcomes of patients undergoing DBE in the community setting. We present our findings regarding the use of DBE in a community hospital. Methods: From March 2007 to January 2011, 88 DBE procedures were performed on 66 patients. Indications included evaluation anemia/gastrointestinal bleed, small bowel IBD and dilation of strictures. Video-capsule endoscopy (VCE) was used prior to DBE in 43 of the 66 patients prior to DBE evaluation. Results: The mean age was 62 years. Thirty-two patients were female, 15 were African-American; 44 antegrade and 44 retrograde DBEs were performed. The mean time per antegrade DBE was 107.4±30.0 minutes with a distance of 318.4±152.9 cm reached past the pylorus. The mean time per lower DBE was 100.7±27.3 minutes with 168.9±109.1 cm meters past the ileocecal valve reached. Endoscopic therapy in the form of electrocautery to ablate bleeding sources was performed in 20 patients (30.3%), biopsy in 17 patients (25.8%) and dilation of Crohn's-related small bowel strictures in 4 (6.1%). 43 VCEs with pathology noted were performed prior to DBE, with findings endoscopically confirmed in 32 cases (74.4%). In 3 cases the DBE showed findings not noted on VCE. Conclusion: DBE appears to be equally safe and effective when performed in the community setting as compared to a tertiary referral center with a comparable yield, efficacy, and complication rate.
PubMed, Mar 13, 1999
To assess the clinical use of the breath hydrogen test in a large community hospital using a <10 ... more To assess the clinical use of the breath hydrogen test in a large community hospital using a <10 ppm cutoff, we reviewed 222 tests performed over a 5-year period to evaluate patients for disaccharidase deficiency or bacterial overgrowth of the small intestine. Of these, the vast majority (195) were for lactose malabsorption, although fructose (17), sucrose (8) and lactulose (2) were also occasionally administered. One hundred eleven tests (50 percent) were positive, with an increase of at least 10 ppm hydrogen above the fasting level and a maximum value most commonly observed (42.3 percent of the time) at 3 hours post-administration. Only 34 patients (15.3 percent) had symptoms noted during the test, as compared with 185 (83.3 percent) who had experienced persistent intestinal problems prior to the test. Recent conditions which may have caused intestinal distress, such as transient disaccharidase deficiency, infections, surgery or other disorders like Crohn's disease, ulcerative colitis or food poisoning, were recorded in only 14 cases. Patterns consistent with bacterial overgrowth of the small intestine were observed in only 3 cases. Of 111 positives, 9 cases had increases between 10 and 20 ppm hydrogen and 7 showed the increase in the 3-hour sample, possibly reflecting a delayed transit through the intestine. Final diagnoses in 6 of these where information was available were for conditions other than malabsorption. We conclude that using a rise of 10 ppm to interpret a positive test does not contribute significantly to an increased frequency of false positives, but that patients with increases between 10 and 20 ppm probably are not lactase deficient.
The American Journal of Gastroenterology, Oct 1, 2014
ACG Case Reports Journal, Jul 1, 2019
Pancreatic cancer carries a poor prognosis and given insidious symptoms has often metastasized at... more Pancreatic cancer carries a poor prognosis and given insidious symptoms has often metastasized at the time of presentation. Common sites of metastasis involve liver, lungs, regional lymph nodes, or peritoneum. Colonic metastasis is rare, with only a few previous descriptions in the literature. We report a case of a 91-year-old woman with presumed pancreatic adenocarcinoma based on pathology and imaging, with colonic metastasis presenting as colonic obstruction.
The American Journal of Gastroenterology, Oct 1, 2004
The American Journal of Gastroenterology, Oct 1, 2010
The American Journal of Gastroenterology, Oct 1, 2010
The American Journal of Gastroenterology, Oct 1, 2010
The American Journal of Gastroenterology, Oct 1, 2017
The American Journal of Gastroenterology, Oct 1, 2020
A 57-year-old man presented with fatigue and 2-week history of melena. Medical history included a... more A 57-year-old man presented with fatigue and 2-week history of melena. Medical history included acromegaly and a desmoid tu-mor invading the superior mesenteric artery, causing a cardiac arrest 11 years earlier. Exam revealed no abdominal tenderness, melena in the rectum, and a hemoglobin of 4.8 gm/dL. An esophagogastroduodenoscopy and colonoscopy revealed no source of bleeding. Capsule endoscopy showed a mass in the small bowel (Figure 1). An anterograde double balloon enteroscopy demonstrated a 4–5-cm mass 300 cm past the pylorus (Figure 2). Biopsies were consistent with a fibrinopurulent exudate. He underwent surgical resection of the mass, and histologic examination revealed a focal high-grade carcinoma with choriocarci-noma features, with clear margins without lymph node involvement (Figure 3). Serum ß-hCG level was 9169 mIU/mL (normal <5 mIU/mL). An ultrasound of both testicles was normal. The patient died 7 weeks later due to multiple intracranial metastases. There have on...
American Journal of Gastroenterology, 2020
INTRODUCTION: Gastric ischemia is a rare disorder due to the generous vascular supply of the stom... more INTRODUCTION: Gastric ischemia is a rare disorder due to the generous vascular supply of the stomach It most commonly is a consequence of severe sepsis, shock, or splanchnic vessel hypoperfusion In extremely rare cases, gas bloat syndrome may cause severe gastric dilation to the extent of causing gastric ischemia Gas bloat syndrome is a known complication of gastric fundoplication in which gastric dilation occurs from the impaired expulsion of trapped air from belching due to the compressive gastric wrap at the distal esophagus Partial fundoplication has led to decrease in the incidence of gas bloat syndrome as compared to the complete technique We present a patient with a history of achalasia treated with Heller myotomy and Dor fundoplication that developed a large gastric ischemic ulcer as a late complication CASE DESCRIPTION/METHODS: An 82-year-old female with history of peptic ulcer disease, gastroparesis, and type II achalasia presented to the hospital with coffee-ground emesis, dysphagia, epigastric pain, and early satiety Two years prior she underwent Heller myotomy and Dor fundoplication and has since complained of these progressively worsening symptoms On presentation, the patient's hemoglobin was 9 3 gm/dL and a pantoprazole drip was initiated CT abdomen revealed severe gastric wall thickening with no gastric volvulus The patient underwent an EGD the following day which revealed inflamed, necrotic, and ulcerated mucosa involving the fundus, gastric body, and antrum Biopsy confirmed ischemic features Doppler ultrasound of the abdomen ruled out an occlusive vascular disease Patients symptoms continued to improve over the next 48 hours and was discharged on pantoprazole, and a short course of a prokinetic and simethicone At discharge, a repeat EGD with Endoflip technique was scheduled at 8 weeks to evaluate the lower esophageal sphincter distensibility Unfortunately, this procedure was delayed due to the COVID pandemic and results are not available at the time of this abstract DISCUSSION: Failure to recognize gas bloat syndrome as a complication after fundoplication can lead to severe gastric distention and ischemia, especially if confounded with emptying disorders such as gastroparesis Endoflip is a promising tool to evaluate the distensibility of the lower esophageal sphincter Further research is needed to validate the use of this technique to evaluate the response to fundoplication and rule out severe tightening of the gastroesophageal junction (Figure Presented)
American Journal of Gastroenterology, 2020
American Journal of Gastroenterology, 2020
American Journal of Gastroenterology, 2017
American Journal of Gastroenterology, 2012
American Journal of Gastroenterology, 2014
American Journal of Gastroenterology, 2012
Introduction: Collagenous sprue (CS), a rare disorder primarily aff ecting the small bowel and st... more Introduction: Collagenous sprue (CS), a rare disorder primarily aff ecting the small bowel and strongly associated with celiac disease, has rarely been reported. Patients historically present with persistent diarrhea, progressive weight loss and severe malabsorption causing multiple nutrient defi ciencies. While the disease fails to respond to a gluten free diet, it carries the burden of celiac disease associated small bowel malignancy. Here, we present the case of an otherwise asymptomatic patient who was noted to have collagenous gastroenteritis, with involvement of not only the small bowel, but the stomach and large intestines. Case: A 32-year-old male with a longstanding history of asymptomatic GERD and idiopathic gastroparesis presented electively for open access endoscopy. Endoscopic evaluation revealed nodular gastropathy, which histologically was compatible with collagenous sprue. Th is was confi rmed by a second pathologist at a tertiary referral center. A subsequent colonoscopy for evaluation of a change in bowel habits was unremarkable endoscopically, but random biopsies did reveal excess intraepithelial lymphocytes and architectural distortion with varying crypt size and spacing. Th e patient went on to have an upper EUS which revealed diff use wall thickening in the cardia, body and fundus with a maximal wall thickness of 6.1 mm noted, most notably in the superfi cial and deep mucosa. Th e patient has remained asymptomatic and continues to follow up as an outpatient. Discussion: Th e etiology and natural history of collagenous sprue has not been elucidated. Th e disease was fi st described in 1947 and histologically confi rmed in 1970. Some reports have estimated that the disease remains asymptomatic for decades. Histologically, atrophy of mucosal villi and excessive subepithelial collagen deposition that may replace crypts is noted. While histologically and clinically similar to celiac disease, CS does not respond to a gluten free diet. Management of CS remains diffi cult due to lack of long term follow up data. Hoerver proposed treatment regimens consist of total parenteral nutrition coupled with immunosuppressive therapy with cortocosteroids and biologic agents. Unfortunately, no clinical marker or pathological hallmark appears to predict which patients might respond to treatment. Patients die from lymphoma of the small bowel and diarrhea, as well as severe malnutrition. Here, we present a case of CS, a rare disease involving most of the gastrointestinal tract, including the stomach, small bowel and colon.
American Journal of Gastroenterology, 2014
American Journal of Gastroenterology, 2017
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Papers by Laurence Stawick