Author Archives: John

Comparing Outcomes Between “Pull” Versus “Push” Percutaneous Endoscopic Gastrostomy in Acute Care Surgery: Under-Reported Pull Percutaneous Endoscopic Gastrostomy Incidence of Tube Dislodgement

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“Percutaneous endoscopic gastrostomy (PEG) tube placement is a commonly performed procedure in trauma patients.Since the establishment of the acute care surgery (ACS)
model, the role of ACS in PEG tube placement in many institutions has expanded. The incidence of PEG tube complications has been under-reported in the literature and varies
widely among the patient populations studied and the definition of complications utilized. Major and minor complications may range from 3% to 26%. Our institution, under an ACS model, has previously reported an overall 25% complication rate with 10% major and 14% minor complications associated with pull PEG.”

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ACG Clinical Guideline: Focal Liver Lesions

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“With the continued dramatic rise in the widespread role of imaging in diagnosis and management of patients, there is a resultant rise in detection of asymptomatic incidental liver lesions. Common imaging modalities in which incidental liver lesions are detected include ultrasonography (US) with or without contrast agent (CEUS), computed tomography (CT), and magnetic resonance imaging (MRI) for abdominal or nonabdominal indications (breast and spine). Studies show a continued upward trend in utilization of CT/MRI/US imaging in adults in the United States and Canada, inevitably resulting in increased detection of incidental FLLs within the liver. In fact, some studies show that up to 52% of patients without cancer have a benign liver lesion at autopsy. The American College of Radiology reports that up to 15% of patients have an incidental liver lesion detected
on routine nonsurveillance imaging. Therefore, it is critical to understand appropriate management of incidentally detected benign FLLs because they have differing clinical implications from malignant lesions such as hepatocellular carcinoma (HCC), intrahepatic cholangiocarcinoma (iCCA), and metastatic disease.”

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Six versus three years of adjuvant imatinib in patients with localized GIST at high risk of relapse

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“Gastrointestinal stromal tumor (GIST) is the most common sarcoma and also a paradigmatic model for precision medicine in solid tumors, with the tyrosine kinase inhibitor
imatinib as a standard first-line treatment in the advanced phase and as adjuvant treatment in KIT- or PDGFRA-mutated GIST.”
Whether a longer duration of imatinib treatment improves disease-free survival (DFS) has not been explored in a randomized setting. The randomized IMADGIST study was initiated in 2014 with the aim to determine whether the prolongation of adjuvant imatinib during 3 additional years improves the outcome of high-risk GIST patients versus a standard total duration of 3 years as recommended by clinical practice guidelines. The primary endpoint was DFS. We report here the results of this clinical study.”

Figure 2 Disease-free survival in the in the 3-years and 6-years arms. (A) DFS in the entire series; (B) DFS in the stratification subgroup with a risk of relapse of 35%-70%; (C) DFS in the stratification subgroup with a risk of relapse >70%; (D) DFS in the stratification subgroup with a risk of relapse >70%, with (solid lines) or without (dotted lines) tumor rupture. CI, confidence interval; DFS, disease-free survival; Est, estimate; HR, hazard ratio; KM, Kaplan-Meier.
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Long-term outcomes after extrahepatic excision of congenital choladocal cysts

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“Congenital choladocal cysts are generally treated by resection of the dilated extrahepatic biliary duct followed by hepaticojejunostomy, but it is associated with postoperative complications, including postoperative cholangitis, intrahepatic calculi, pancreatitis, and carcinogenesis, in the remnant bile duct. We investigated the most common long-term complications and identified the factors implicated in their development.”

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Pancreatitis after Biliary Tract Surgery (Historical article)

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“Acute pancreatitis after operation on the biliary tract is a serious complication. This study was undertaken in an attempt to determine predisposing factors which might exist in patients undergoing operation for biliary tract disease. A large number of patients have been studied by postoperative serum amylase determinations and correlations have been made between the performance of various procedures and the occurrence of clinical and subclinical pancreatitis.”

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Does the use of staple line reinforcement during sleeve gastrectomy and Roux-en-Y gastric bypass affect Clinical Outcomes?

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“The efficacy of bariatric surgery in facilitating sustained weight loss and managing obesity-related comorbidities has been consistently reported in the medical/scientific literature. Sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGB) are widely accepted bariatric procedures. However, complications, such as gastric leakage, bleeding, stricture, and surgical infection, can lead to significant morbidity and mortality, posing a formidable challenge to bariatric surgeons.
In order to reduce the incidence of complications associated with bariatric surgery, some surgeons have advocated the use of gastric incision staple line reinforcement with the
aim of improving structural integrity and reducing edge tension. However, others have suggested that the reinforcement of the incision edge may compromise suture stability, thereby raising concerns about the overall effectiveness of staple line reinforcement in preventing postoperative complications.”

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Risk of Major Nonemergent Inpatient General Surgical Procedures in Patients on Long-term Dialysis

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“More than half a million individuals in the United States undergo dialysis, a number that has been forecasted to increase by 7% annually. End-stage renal disease requiring dialysis is associated with poor health care outcomes, including a 10-fold increase in risk of hospitalization and an expected lifespan between one-fourth and one-sixth of that of the general population. Despite the well-described outcomes of the effect of end-stage renal disease on community-dwelling individuals, little is known about the contribution of long-term dialysis to the risks of postoperative complications and death.”

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