Papers by Majidah Bukhari
American Journal of Gastroenterology, 2013
American Journal of Gastroenterology, 2017
Gastrointestinal endoscopy, 2018
ERCP is challenging in patients with Roux-en-Y gastric bypass (RYGB) anatomy. EUS-guided gastroga... more ERCP is challenging in patients with Roux-en-Y gastric bypass (RYGB) anatomy. EUS-guided gastrogastrostomy (GG) creation is a promising novel technique to access the excluded stomach to facilitate conventional ERCP. We aimed to compare procedural outcomes and adverse events (AEs) between EUS-guided GG-assisted ERCP (EUS-GG-ERCP) and enteroscopy-assisted ERCP (e-ERCP) in patients with RYGB. Patients with RYGB anatomy who underwent EUS-GG-ERCP or e-ERCP between 2014 and 2016 at 5 tertiary centers were included. The primary outcome was technical success of ERCP, defined as successful cannulation of the selected duct with successful intervention as intended. Secondary outcomes included total procedural time (in the EUS-GG group, total procedural time included EUS-GG creation plus ERCP procedure time), length of hospital stay, and rate/severity of AEs graded according to the American Society for Gastrointestinal Endoscopy lexicon. A total of 60 patients (mean age, 57.2 ± 13.2; 75% women)...
Gastrointestinal endoscopy, Apr 1, 2018
This article has been retracted: please see Elsevier Policy on Article Withdrawal (https://www.el... more This article has been retracted: please see Elsevier Policy on Article Withdrawal (https://www.elsevier.com/about/our-business/policies/article-withdrawal). This article has been retracted due to overlapping/duplicate material. Data from some patients from this study have previously been published in other journals without cross-referencing. Twenty patients overlap with a paper by Kumbhari et al. Thirty-five patients overlap with the study by Ngamruengphong et al..
Endoscopy, Jan 2, 2018
Afferent loop syndrome (ALS) is traditionally managed surgically and, more recently, endoscopica... more Afferent loop syndrome (ALS) is traditionally managed surgically and, more recently, endoscopically. The role of endoscopic ultrasound-guided entero-enterostomy (EUS-EE) has not been well described. The aim of this study was to assess the technical and clinical success and safety of EUS-EE. This was a multicenter, retrospective series at six centers in patients with ALS treated by EUS-EE. Data on patients treated with enteroscopy-assisted luminal stenting (EALS) at a single center were also collected. 18 patients (mean age 64.2 years, 72 % post-pancreaticoduodenectomy, 10 female) underwent EUS-EE. The most common symptoms were vomiting (27.8 %) and jaundice (33.3 %). Clinical success included resolution of symptoms in 88.9 % and improvement to allow hospital discharge in 11.1 %. Technical success was achieved in 100 % of cases, with a mean procedure time of 29.7 minutes. The most common procedure was a gastro-jejunostomy (72.2 %). Three adverse events (16.7 %) occurred (two mild,...
Gastrointestinal Endoscopy, 2017
treatment protocol was unchanged (1.7% vs. 2.5%, pZ0.581). Conclusion: Despite an increase in ref... more treatment protocol was unchanged (1.7% vs. 2.5%, pZ0.581). Conclusion: Despite an increase in referral bias and proportion of patients with IMC, we report continued achievement of CRIM and improved achievement of CRD with RFA over time. The improvement may be multifactorial, including evolved RFA tools, advanced endoscopic imaging techniques, and improved endoscopic skill.
Gastrointestinal Endoscopy, 2017
Introduction: Biliary obstruction is a frequent complication of pancreaticobiliary malignancy. En... more Introduction: Biliary obstruction is a frequent complication of pancreaticobiliary malignancy. Endoscopic retrograde cholangiopancreatography (ERCP) with stent placement is the standard of care treatment for these patients. Radiofrequency
Surgical endoscopy, Sep 1, 2017
The correct Family Name of the eighth author is ''Ngamruengphong''.
Gastrointestinal endoscopy, Jan 24, 2017
Endoscopic ultrasound-guided gastroenterostomy (EUS-GE) is a developing modality in the managemen... more Endoscopic ultrasound-guided gastroenterostomy (EUS-GE) is a developing modality in the management of gastric outlet obstruction (GOO) with several technical approaches including the direct and balloon-assisted techniques. The aim of this study is to compare the direct with the balloon-assisted modality while further defining the role of EUS-GE in GOO. Multicenter, retrospective study involving consecutive patients who underwent EUS gastroenterostomy with the direct or balloon-assisted technique for GOO (January 2014-October 2016). The primary outcome is technical success. Secondary outcomes include clinical success (ability to tolerate at least a full fluid diet), procedure time, and rate/severity of adverse events (AE). Seventy-seven patients (42.9% female; mean age 63.2 ± 11.5 years) underwent EUS gastroenterostomy for GOO (n=55 DGE and n=22 BAGE). GOO was of malignant and benign etiology in 67.5% and 32.5% of the patients, respectively. Technical success was achieved in 94.5% of...
Endoscopy, Jan 10, 2017
Background and aims Endoscopic retrograde cholangiopancreatography (ERCP) in patients who have un... more Background and aims Endoscopic retrograde cholangiopancreatography (ERCP) in patients who have undergone Roux-en-Y gastric bypass (RYGB) is technically challenging. We describe our multicenter experience using lumen-apposing metal stents (LAMSs) to create an endoscopic ultrasound-guided transgastric fistula (EUS-TG) to facilitate peroral ERCP in these patients. Patients and methods Thirteen patients with RYGB who underwent EUS-TG at three tertiary centers were included. EUS was used to guide puncture of the excluded stomach from the gastric pouch or jejunum; a LAMS was placed across the transgastric fistula. ERCP was performed via a duodenoscope passed through the LAMS. Results The technical success of EUS-TG was 100 % (13/13). ERCP through the LAMS was successful and clinical success was achieved in all patients. LAMS dislodgement during ERCP occurred in two patients and the stent was successfully repositioned without sequelae. After removal of the LAMS, the fistula was closed in 9...
Gastrointestinal endoscopy, Jan 21, 2017
Per-oral endoscopic myotomy (POEM) for achalasia is particularly appealing in the elderly due to ... more Per-oral endoscopic myotomy (POEM) for achalasia is particularly appealing in the elderly due to its minimally invasiveness; however, data in patients age ≥ 80 years are scarce. The aim of this study was to assess the clinical outcome of POEM in octogenarians. Multicenter retrospective study at 8 centers. Consecutive octogenarians with achalasia who underwent POEM between 2010 and 2016 were included. Rates of technical success (completion of myotomy), clinical response (Eckardt score ≤3), and adverse events (AEs) (severity graded as per American Society for Gastrointestinal Endoscopy [ASGE] lexicon) were assessed. A total of 76 patients (47.4% female, mean age 84 years) underwent POEM for treatment of achalasia: type I 17.1%, type II 35.5%, type III 17.1%, and unspecified 30.3%. Overall, 41.1% were treatment naive whereas others had previous botulinum injection and/or pneumatic dilation. The mean age-adjusted Charlson comorbidity index was 6.2 ± 2.4 with the majority of patients ASA...
Surgical endoscopy, Jul 10, 2016
Endoscopic enteral stenting (ES) in malignant gastric outlet obstruction (GOO) is limited by high... more Endoscopic enteral stenting (ES) in malignant gastric outlet obstruction (GOO) is limited by high rates of stent obstruction. EUS-guided gastroenterostomy (EUS-GE) is a novel procedure that potentially offers sustained patency without tumor ingrowth/overgrowth. The aim of this study is to compare EUS-GE with ES in terms of (1) symptom recurrence and need for re-intervention, (2) technical success (proper stent positioning as determined via endoscopy and fluoroscopy), (3) clinical success (ability to tolerate oral intake without vomiting), and (4) procedure-related adverse events (AEs). Multicenter retrospective study of all consecutive patients who underwent either EUS-GE at four centers between 2013 and 2015 or ES at one center between 2008 and 2010. A total of 82 patients (mean age 66-years ± 13.5 and 40.2% female) were identified: 30 in EUS-GE and 52 in ES. Technical and clinical success was not significantly different: 86.7% EUS-GE versus 94.2% ES (p = 0.2) and 83.3% EUS-GE vers...
Digestive Diseases and Sciences, 2016
Spastic esophageal disorders (SEDs) include spastic achalasia (type III), diffuse esophageal spas... more Spastic esophageal disorders (SEDs) include spastic achalasia (type III), diffuse esophageal spasm (DES), and nutcracker/jackhammer esophagus (JH). Per-oral endoscopic myotomy (POEM) has demonstrated efficacy and safety in the treatment of achalasia. Recently, POEM has been indicated for the treatment of SEDs. We conducted a systematic review and meta-analysis to determine the clinical success and safety of POEM in SEDs. We searched several databases from 01/01/2007 to 01/10/2016 to identify studies (with five or more patients) on POEM for the treatment of SEDs. Weighted pooled rates (WPRs) for clinical success and adverse events (AEs) were calculated for all SEDs. Clinical success was defined as Eckardt scores of ≤3 and/or improvement in severity of dysphagia based on achalasia disease-specific health-related quality of life questionnaire. The WPRs for clinical success and AEs were analyzed using fixed- or random-effects model based on heterogeneity. The proportionate difference in clinical success and post-procedure adverse event rates among individual types of SEDs was also calculated. A total of eight observational studies with 179 patients were included in the final analysis. Two studies were of good quality and six were of fair quality based on the National Institutes of Health quality assessment tool. The WPR with 95% confidence interval (CI) for cumulative clinical success of POEM in all SEDs was 87% (78, 93%), I (2) = 37%. The total number of patients for individual disorders, i.e., type III achalasia, JH, and DES, was 116, 37, and 18, respectively. The WPRs for clinical success of POEM for type III achalasia, DES, and JH were 92, 88, and 72%, respectively. Proportion difference of WPR for clinical success was significantly higher for type III achalasia in comparison with JH (20%, P = 0.01). The WPR with 95% CI for AEs of POEM in all SEDs was 14% (9, 20%), I (2) = 0%. The WPRs for post-procedure adverse events for type III achalasia, DES, and JH were 11, 14, and 16%, respectively. There was no difference in safety of POEM among individual SEDs. POEM is an effective and safe therapeutic modality for the treatment of spastic esophageal disorders.
Gastrointestinal Endoscopy, 2016
Gastroenterology, 2016
INTRODUCTION Is it well known that obstructive jaundice is a frequent cause of access in Emergenc... more INTRODUCTION Is it well known that obstructive jaundice is a frequent cause of access in Emergency Department (ED), with or without cholangitis, and this requires a rapid management with hospitalization in surgical or gastroenterology unit to perform ERCP and to solve the problem. To reduce the problem of overcrowding and too many hospital admissions in Italian's ED were added Brief Observation Unit (BOU), small units located close to the ED in which patients are treated for 48-72h with a significant decrease of regular admission costs. Aim of our study was evaluate the efficacy of a new model of managing acute obstructive jaundice with ERCP procedures directly from BOU, instead of admitting patients to long and unnecessary periods of hospitalization PATIENTS AND METHODS We enrolled from July 2014 to November 2015, 172 consecutive patients (102M/70F mean age 66,7 +-13,5) who came to our ED of Gemelli Hospital with an acute obstructive jaundice with the indication to perform ERCP Routine blood tests including LFTs, chest x-ray, EKG, abdominal ultrasound (or CT scan if needed) were performed and the patient sent urgently to perform ERCP. After ERCP patients were hospitalized for a short observation in the BOU. RESULTS Indications for ERCP are summarized in the table Overall, 132 / 172 patients (76.7 %) were discharged the day after the procedure or within 48 hours from admission (p<0.0001). Biliary stent clogging, unresectable pancreatic cancer and removal of biliary stones are the diseases in which treatment determined a significantly high probability of discharge directly form BOU, differently from cholangitis with incomplete drainage from other facilities or acute biliary pancreatitis, which always require regular hospital admission (p<0.0001). This model allowed to significantly reduce the total costs of management of those diseases (291 vs 1058 USD per day for each patient; p<0.0001). DISCUSSION AND CONCLUSIONS Our study showed the effectiveness of BOU in the managing of patients with acute obstructive jaundice who needs ERCP, especially for those who underwent for removal of biliary stones or biliary stent clogging. All of these patients were admitted to BOU, thereby reducing the cost and time of hospitalization. This approach decreases unnecessary inpatient admission, reduces timing of procedures actuation and allows a faster and appropriate managing of the patients.
Gastrointestinal Endoscopy, 2016
very low as well as the overall morbidity and mortality rate. The need for prophylactic antibioti... more very low as well as the overall morbidity and mortality rate. The need for prophylactic antibiotics to prevent early wound infection has not been proven.
Gastrointestinal endoscopy, Jan 23, 2016
Endoscopic management of post-Whipple pancreatic adverse events with enteroscopy-assisted endosco... more Endoscopic management of post-Whipple pancreatic adverse events with enteroscopy-assisted endoscopic retrograde pancreatography (e-ERP) is associated with high failure rates. EUS guided-pancreatic duct drainage (EUS-PDD) has shown promising results; however, there have been no comparative data looking at these two modalities. The goal of this study is to compare EUS-PDD with e-ERP in terms of technical success (PDD through dilation/stent), clinical success (improvement/resolution of pancreatic-type symptoms) and adverse event (AE) rates in patients with post-Whipple anatomy. This is an international multicenter comparative retrospective study at 7 tertiary centers (2 United States, 2 European, 2 Asian, and 1 South American). All consecutive patients who underwent EUS-PDD or e-ERP between January 2010 and August 2015 were included. A total of 66 patients (mean age 57, 48% female) and 75 procedures were identified with 40 in EUS-PDD and 35 in e-ERP. Technical success was achieved in 9...
Gastrointestinal Endoscopy, 2016
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Papers by Majidah Bukhari