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  1. Article ; Online: The Cutting Edge: Doppler Probe in Guiding Endoscopic Hemostasis.

    Ghassemi, Kevin A / Jensen, Dennis M

    Gastrointestinal endoscopy clinics of North America

    2018  Volume 28, Issue 3, Page(s) 321–330

    Abstract: This article examines use of the Doppler endoscopic probe (DEP) for risk stratification and as a guide to definitive hemostasis of nonvariceal upper gastrointestinal (NVUGI) bleeding and colonic diverticular hemorrhage. Studies report that lesions with ... ...

    Abstract This article examines use of the Doppler endoscopic probe (DEP) for risk stratification and as a guide to definitive hemostasis of nonvariceal upper gastrointestinal (NVUGI) bleeding and colonic diverticular hemorrhage. Studies report that lesions with high-risk stigmata of recent hemorrhage (SRH) have a higher rate of a positive DEP signal compared with those without such SRH. Lesions with a persistently positive DEP signal after endoscopic hemostasis have a higher 30-day rebleeding rate. Studies document arterial blood flow underneath stigmata of recent hemorrhage as a risk factor for rebleeding of focal nonvariceal gastrointestinal lesions. With DEP probe as a guide, rates of definitive endoscopic hemostasis and clinical outcomes are improved compared with standard visually guided treatment.
    MeSH term(s) Endosonography/instrumentation ; Endosonography/methods ; Gastrointestinal Hemorrhage/therapy ; Gastrointestinal Tract/diagnostic imaging ; Hemostasis, Endoscopic/instrumentation ; Hemostasis, Endoscopic/methods ; Humans ; Ultrasonography, Doppler/instrumentation ; Ultrasonography, Doppler/methods
    Language English
    Publishing date 2018-04-12
    Publishing country United States
    Document type Journal Article ; Review
    ZDB-ID 1313994-0
    ISSN 1558-1950 ; 1052-5157
    ISSN (online) 1558-1950
    ISSN 1052-5157
    DOI 10.1016/j.giec.2018.02.005
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  2. Article ; Online: What Does Lesion Blood Flow Tell Us About Risk Stratification and Successful Management of Non-variceal UGI Bleeding?

    Ghassemi, Kevin A / Jensen, Dennis M

    Current gastroenterology reports

    2017  Volume 19, Issue 4, Page(s) 17

    Abstract: Purpose of review: There has been a decline in mortality associated with upper gastrointestinal (UGI) hemorrhage as the use of urgent endoscopy has increased. This review will examine endoscopic risk stratification of non-variceal UGI bleeding (e.g., ... ...

    Abstract Purpose of review: There has been a decline in mortality associated with upper gastrointestinal (UGI) hemorrhage as the use of urgent endoscopy has increased. This review will examine endoscopic risk stratification of non-variceal UGI bleeding (e.g., ulcers, Dieulafoy lesions, and Mallory-Weiss tears), including the use of the Doppler endoscopic probe (DEP).
    Recent findings: Prospective studies evaluating the use of DEP in non-variceal UGI hemorrhage showed that lesions with high-risk stigmata of recent hemorrhage (SRH) have a higher rate of a positive DEP signal compared to those with intermediate-risk SRH. Additionally, lesions with a persistently positive DEP signal after endoscopic hemostasis were seen with high-risk SRH and had a higher 30-day rebleeding rate. Residual arterial blood flow underneath ulcers is a significant risk factor for rebleeding. However, if more endoscopic treatment is applied, clinical outcomes for patients with severe non-variceal UGI hemorrhage are improved, as documented by a recent CURE Hemostasis randomized controlled trial (RCT).
    MeSH term(s) Endoscopy, Gastrointestinal/methods ; Endosonography/methods ; Gastrointestinal Hemorrhage/diagnosis ; Gastrointestinal Hemorrhage/therapy ; Gastrointestinal Tract/blood supply ; Hemostasis, Endoscopic/methods ; Humans ; Regional Blood Flow ; Risk Assessment/methods
    Language English
    Publishing date 2017-04
    Publishing country United States
    Document type Journal Article ; Review
    ZDB-ID 2041376-2
    ISSN 1534-312X ; 1522-8037
    ISSN (online) 1534-312X
    ISSN 1522-8037
    DOI 10.1007/s11894-017-0556-y
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  3. Article ; Online: Evolving techniques for gastrointestinal endoscopic hemostasis treatment.

    Ghassemi, Kevin A / Jensen, Dennis M

    Expert review of gastroenterology & hepatology

    2016  Volume 10, Issue 5, Page(s) 615–623

    Abstract: With mortality due to gastrointestinal (GI) bleeding remaining stable, the focus on endoscopic hemostasis has been on improving other outcomes such as rebleeding rate, need for transfusions, and need for angiographic embolization or surgery. Over the ... ...

    Abstract With mortality due to gastrointestinal (GI) bleeding remaining stable, the focus on endoscopic hemostasis has been on improving other outcomes such as rebleeding rate, need for transfusions, and need for angiographic embolization or surgery. Over the past few years, a number of devices have emerged to help endoscopically assess and treat bleeding GI lesions. These include the Doppler endoscopic probe, hemostatic powder, and over-the-scope clip. Also, new applications have been described for radiofrequency ablation. In this article, we will discuss these evolving tools and techniques that have been developed, including an analysis of their efficacy and limitations.
    MeSH term(s) Catheter Ablation/adverse effects ; Catheter Ablation/instrumentation ; Catheter Ablation/mortality ; Endoscopes, Gastrointestinal ; Endoscopy, Gastrointestinal/adverse effects ; Endoscopy, Gastrointestinal/instrumentation ; Endoscopy, Gastrointestinal/methods ; Endoscopy, Gastrointestinal/mortality ; Equipment Design ; Gastrointestinal Hemorrhage/diagnosis ; Gastrointestinal Hemorrhage/mortality ; Gastrointestinal Hemorrhage/therapy ; Hemostasis, Endoscopic/adverse effects ; Hemostasis, Endoscopic/instrumentation ; Hemostasis, Endoscopic/methods ; Hemostasis, Endoscopic/mortality ; Hemostatics/administration & dosage ; Hemostatics/adverse effects ; Humans ; Risk Factors ; Treatment Outcome
    Chemical Substances Hemostatics
    Keywords covid19
    Language English
    Publishing date 2016-01-11
    Publishing country England
    Document type Journal Article ; Research Support, N.I.H., Extramural ; Research Support, U.S. Gov't, Non-P.H.S. ; Review
    ZDB-ID 2481021-6
    ISSN 1747-4132 ; 1747-4124
    ISSN (online) 1747-4132
    ISSN 1747-4124
    DOI 10.1586/17474124.2016.1130623
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  4. Article ; Online: Trends in Esophageal Cancer Mortality and Stage at Diagnosis by Race and Ethnicity in the United States.

    Corona, Edgar / Yang, Liu / Esrailian, Eric / Ghassemi, Kevin A / Conklin, Jeffrey L / May, Folasade P

    Cancer causes & control : CCC

    2021  Volume 32, Issue 8, Page(s) 883–894

    Abstract: Introduction: Esophageal cancer (EC) is an aggressive malignancy with poor prognosis. Mortality and disease stage at diagnosis are important indicators of improvements in cancer prevention and control. We examined United States trends in esophageal ... ...

    Abstract Introduction: Esophageal cancer (EC) is an aggressive malignancy with poor prognosis. Mortality and disease stage at diagnosis are important indicators of improvements in cancer prevention and control. We examined United States trends in esophageal adenocarcinoma (EAC) and esophageal squamous cell carcinoma (ESCC) mortality and stage at diagnosis by race and ethnicity.
    Methods: We used Surveillance, Epidemiology, and End Results (SEER) data to identify individuals with histologically confirmed EAC and ESCC between 1 January 1992 and 31 December 2016. For both EAC and ESCC, we calculated age-adjusted mortality and the proportion presenting at each stage by race/ethnicity, sex, and year. We then calculated the annual percent change (APC) in each indicator by race/ethnicity and examined changes over time.
    Results: The study included 19,257 EAC cases and 15,162 ESCC cases. EAC mortality increased significantly overall and in non-Hispanic Whites from 1993 to 2012 and from 1993 to 2010, respectively. EAC mortality continued to rise among non-Hispanic Blacks (NHB) (APC = 1.60, p = 0.01). NHB experienced the fastest decline in ESCC mortality (APC = - 4.53, p < 0.001) yet maintained the highest mortality at the end of the study period. Proportions of late stage disease increased overall by 18.5 and 24.5 percentage points for EAC and ESCC respectively; trends varied by race/ethnicity.
    Conclusion: We found notable differences in trends in EAC and ESCC mortality and stage at diagnosis by race/ethnicity. Stage migration resulting from improvements in diagnosis and treatment may partially explain recent trends in disease stage at diagnosis. Future efforts should identify factors driving current esophageal cancer disparities.
    MeSH term(s) Adenocarcinoma/pathology ; Adult ; Esophageal Neoplasms/pathology ; Esophageal Squamous Cell Carcinoma/pathology ; Ethnic Groups ; Female ; Head and Neck Neoplasms/pathology ; Humans ; Incidence ; Male ; United States
    Language English
    Publishing date 2021-05-18
    Publishing country Netherlands
    Document type Journal Article
    ZDB-ID 1064022-8
    ISSN 1573-7225 ; 0957-5243
    ISSN (online) 1573-7225
    ISSN 0957-5243
    DOI 10.1007/s10552-021-01443-z
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    Zs.A 3375: Show issues Location:
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  5. Article ; Online: Developing an electronic health record measure of low-value esophagogastroduodenoscopy for GERD at a large academic health system.

    Reynolds, Courtney A / Nair, Vishnu / Villaflores, Chad / Dominguez, Katherine / Arbanas, Julia Cave / Treasure, Madeline / Skootsky, Samuel / Tseng, Chi-Hong / Sarkisian, Catherine / Patel, Arpan / Ghassemi, Kevin / Fendrick, A Mark / May, Folasade P / Mafi, John N

    BMJ open quality

    2023  Volume 12, Issue 4

    Abstract: Objectives: Low-value esophagogastroduodenoscopies (EGDs) for uncomplicated gastro-oesophageal reflux disease (GERD) can harm patients and raise patient and payer costs. We developed an electronic health record (EHR) 'eMeasure' to detect low-value EGDs.! ...

    Abstract Objectives: Low-value esophagogastroduodenoscopies (EGDs) for uncomplicated gastro-oesophageal reflux disease (GERD) can harm patients and raise patient and payer costs. We developed an electronic health record (EHR) 'eMeasure' to detect low-value EGDs.
    Design: Retrospective cohort of 518 adult patients diagnosed with GERD who underwent initial EGD between 1 January 2019 and 31 December 2019.
    Setting: Outpatient primary care and gastroenterology clinics at a large, urban, academic health centre.
    Participants: Adult primary care patients at the University of California Los Angeles who underwent initial EGD for GERD in 2019.
    Main outcome measures: EGD appropriateness criteria were based on the American College of Gastroenterology 2012 guidelines. An initial EGD was considered low-value if it lacked a documented guideline-based indication, including alarm symptoms (eg, iron-deficiency anaemia); failure of an 8-week proton pump inhibitor trial or elevated Barrett's oesophagus risk. We performed manual chart review on a random sample of 204 patients as a gold standard of the eMeasure's validity. We estimated EGD costs using Medicare physician and facility fee rates.
    Results: Among 518 initial EGDs performed (mean age 53 years; 54% female), the eMeasure identified 81 (16%) as low-value. The eMeasure's sensitivity was 42% (95% CI 22 to 61) and specificity was 93% (95% CI 89 to 96). Stratifying across clinics, 62 (74.6%) low-value EGDs originated from 2 (12.5%) out of 16 clinics. Total cost for 81 low-value EGDs was approximately US$75 573, including US$14 985 in patients' out-of-pocket costs.
    Conclusions: We developed a highly specific eMeasure that showed that low-value EGDs occurred frequently in our healthcare system and were concentrated in a minority of clinics. These results can inform future QI efforts at our institution, such as best practice alerts for the ordering physician. Moreover, this open-source eMeasure has a much broader potential impact, as it can be integrated into any EHR and improve medical decision-making at the point of care.
    MeSH term(s) Adult ; Humans ; Female ; Aged ; United States ; Middle Aged ; Male ; Retrospective Studies ; Electronic Health Records ; Medicare ; Gastroesophageal Reflux/diagnosis ; Gastroesophageal Reflux/complications ; Endoscopy, Digestive System/methods
    Language English
    Publishing date 2023-12-22
    Publishing country England
    Document type Journal Article ; Research Support, N.I.H., Extramural
    ISSN 2399-6641
    ISSN (online) 2399-6641
    DOI 10.1136/bmjoq-2023-002363
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  6. Article ; Online: Randomized Controlled Trial of Over-the-Scope Clip as Initial Treatment of Severe Nonvariceal Upper Gastrointestinal Bleeding.

    Jensen, Dennis M / Kovacs, Thomas / Ghassemi, Kevin A / Kaneshiro, Marc / Gornbein, Jeffrey

    Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association

    2020  Volume 19, Issue 11, Page(s) 2315–2323.e2

    Abstract: Background and aims: No prior randomized controlled trial (RCT) has reported patient outcomes of large over-the-scope clip (OTSC) compared to standard hemostasis as initial endoscopic treatment of severe NVUGIB. This was our study aim.: Methods: ... ...

    Abstract Background and aims: No prior randomized controlled trial (RCT) has reported patient outcomes of large over-the-scope clip (OTSC) compared to standard hemostasis as initial endoscopic treatment of severe NVUGIB. This was our study aim.
    Methods: Patients with bleeding ulcers or Dieulafoy's lesions and major stigmata of hemorrhage - SRH (active spurting bleeding, visible vessel, or clot) - or lesser SRH (oozing bleeding or flat spots - with arterial blood flow by Doppler probe) were randomized to OTSC or standard endoscopic hemostasis (with hemoclips or multipolar electrocoagulation - MPEC). Patients and their healthcare providers were blinded to treatments and made all post-randomization management decisions. Ulcer patients received high dose intravenous infusions of proton pump inhibitors (PPI) for 3 days, then 27 days of oral PPI. 30 day outcomes were prospectively recorded; data management was with SAS; and data analysis was by a statistician.
    Results: 53 patients (25 OTSC, 28 Standard) were randomized, with similar baseline risk factors. However, there were significant differences in OTSC vs. Standard groups in rates of rebleeding (4% vs. 28.6%; p = .017; relative risk 0.10, 95% confidence intervals 0.01, 0.91; number needed to treat 4); severe complications (0 % vs. 14.3%); and post-randomization units of red cell transfusions (0.04 vs. 0.68). All rebleeds occurred in patients with major SRH and none with lesser SRH.
    Conclusion: 1. OTSC significantly reduced rates of rebleeding, severe complications, and post-randomization red cell transfusions. 2. Patients with major stigmata benefited significantly from hemostasis with OTSC, but those with lesser stigmata did not. (ClinicalTrials.gov, Number: NCT03065465).
    MeSH term(s) Gastrointestinal Hemorrhage/therapy ; Hemostasis, Endoscopic ; Humans ; Proton Pump Inhibitors ; Surgical Instruments ; Treatment Outcome
    Chemical Substances Proton Pump Inhibitors
    Language English
    Publishing date 2020-08-20
    Publishing country United States
    Document type Journal Article ; Randomized Controlled Trial ; Research Support, N.I.H., Extramural ; Research Support, Non-U.S. Gov't
    ZDB-ID 2119789-1
    ISSN 1542-7714 ; 1542-3565
    ISSN (online) 1542-7714
    ISSN 1542-3565
    DOI 10.1016/j.cgh.2020.08.046
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  7. Article ; Online: Lower GI bleeding: epidemiology and management.

    Ghassemi, Kevin A / Jensen, Dennis M

    Current gastroenterology reports

    2013  Volume 15, Issue 7, Page(s) 333

    Abstract: Gastrointestinal (GI) bleeding from the colon is a common reason for hospitalization and is becoming more common in the elderly. While most cases will cease spontaneously, patients with ongoing bleeding or major stigmata of hemorrhage require urgent ... ...

    Abstract Gastrointestinal (GI) bleeding from the colon is a common reason for hospitalization and is becoming more common in the elderly. While most cases will cease spontaneously, patients with ongoing bleeding or major stigmata of hemorrhage require urgent diagnosis and intervention to achieve definitive hemostasis. Colonoscopy is the primary modality for establishing a diagnosis, risk stratification, and treating some of the most common causes of colonic bleeding, including diverticular hemorrhage which is the etiology in 30% of cases. Other interventions, including angiography and surgery, are usually reserved for instances of bleeding that cannot be stabilized or allow for adequate bowel preparation for colonoscopy. We discuss the colonoscopic diagnosis, risk stratification, and definitive treatment of colonic hemorrhage in patients presenting with severe hematochezia.
    MeSH term(s) Colonic Diseases/epidemiology ; Colonic Diseases/etiology ; Colonic Diseases/therapy ; Colonoscopy/methods ; Diagnosis, Differential ; Gastrointestinal Hemorrhage/epidemiology ; Gastrointestinal Hemorrhage/etiology ; Gastrointestinal Hemorrhage/therapy ; Hemostatic Techniques ; Humans
    Language English
    Publishing date 2013-05-31
    Publishing country United States
    Document type Journal Article ; Review
    ZDB-ID 2041376-2
    ISSN 1534-312X ; 1522-8037
    ISSN (online) 1534-312X
    ISSN 1522-8037
    DOI 10.1007/s11894-013-0333-5
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  8. Article ; Online: Uses of probe-based confocal laser endomicroscopy: responses to a question to practitioners.

    Paul, Navin / Ghassemi, Kevin A

    World journal of gastroenterology

    2011  Volume 17, Issue 42, Page(s) 4739–4740

    Abstract: Confocal laser endomicroscopy is a novel imaging technology, which allows real-time visualization and interpretation of microscopic details in live tissues. Although several potential uses have been identified for this technology, no data are available ... ...

    Abstract Confocal laser endomicroscopy is a novel imaging technology, which allows real-time visualization and interpretation of microscopic details in live tissues. Although several potential uses have been identified for this technology, no data are available regarding its real-world uses. We report the results of an email-based survey of experts in North America regarding their use of the technology.
    MeSH term(s) Animals ; Endoscopy/methods ; Gastrointestinal Neoplasms/pathology ; Gastrointestinal Tract/pathology ; Humans ; Lasers ; Microscopy, Confocal/methods ; Neovascularization, Pathologic/pathology
    Language English
    Publishing date 2011-12-16
    Publishing country United States
    Document type Letter ; Comment
    ZDB-ID 2185929-2
    ISSN 2219-2840 ; 1007-9327
    ISSN (online) 2219-2840
    ISSN 1007-9327
    DOI 10.3748/wjg.v17.i42.4739
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  9. Article ; Online: Developing an electronic health record measure of low-value esophagogastroduodenoscopy for GERD at a large academic health system

    Chi-Hong Tseng / Arpan Patel / John N Mafi / Folasade P May / Catherine Sarkisian / Courtney A Reynolds / Vishnu Nair / Chad Villaflores / Katherine Dominguez / Julia Cave Arbanas / Madeline Treasure / Samuel Skootsky / Kevin Ghassemi / A Mark Fendrick

    BMJ Open Quality, Vol 12, Iss

    2023  Volume 4

    Abstract: Objectives Low-value esophagogastroduodenoscopies (EGDs) for uncomplicated gastro-oesophageal reflux disease (GERD) can harm patients and raise patient and payer costs. We developed an electronic health record (EHR) ‘eMeasure’ to detect low-value EGDs ... ...

    Abstract Objectives Low-value esophagogastroduodenoscopies (EGDs) for uncomplicated gastro-oesophageal reflux disease (GERD) can harm patients and raise patient and payer costs. We developed an electronic health record (EHR) ‘eMeasure’ to detect low-value EGDs.Design Retrospective cohort of 518 adult patients diagnosed with GERD who underwent initial EGD between 1 January 2019 and 31 December 2019.Setting Outpatient primary care and gastroenterology clinics at a large, urban, academic health centre.Participants Adult primary care patients at the University of California Los Angeles who underwent initial EGD for GERD in 2019.Main outcome measures EGD appropriateness criteria were based on the American College of Gastroenterology 2012 guidelines. An initial EGD was considered low-value if it lacked a documented guideline-based indication, including alarm symptoms (eg, iron-deficiency anaemia); failure of an 8-week proton pump inhibitor trial or elevated Barrett’s oesophagus risk. We performed manual chart review on a random sample of 204 patients as a gold standard of the eMeasure’s validity. We estimated EGD costs using Medicare physician and facility fee rates.Results Among 518 initial EGDs performed (mean age 53 years; 54% female), the eMeasure identified 81 (16%) as low-value. The eMeasure’s sensitivity was 42% (95% CI 22 to 61) and specificity was 93% (95% CI 89 to 96). Stratifying across clinics, 62 (74.6%) low-value EGDs originated from 2 (12.5%) out of 16 clinics. Total cost for 81 low-value EGDs was approximately US$75 573, including US$14 985 in patients’ out-of-pocket costs.Conclusions We developed a highly specific eMeasure that showed that low-value EGDs occurred frequently in our healthcare system and were concentrated in a minority of clinics. These results can inform future QI efforts at our institution, such as best practice alerts for the ordering physician. Moreover, this open-source eMeasure has a much broader potential impact, as it can be integrated into any EHR and improve medical decision-making at ...
    Keywords Medicine (General) ; R5-920
    Language English
    Publishing date 2023-12-01T00:00:00Z
    Publisher BMJ Publishing Group
    Document type Article ; Online
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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  10. Article ; Online: Uses of probe-based confocal laser endomicroscopy

    Navin Paul / Kevin A Ghassemi

    World Journal of Gastroenterology, Vol 17, Iss 42, Pp 4739-

    Responses to a question to practitioners

    2011  Volume 4740

    Abstract: Confocal laser endomicroscopy is a novel imaging technology, which allows real-time visualization and interpretation of microscopic details in live tissues. Although several potential uses have been identified for this technology, no data are available ... ...

    Abstract Confocal laser endomicroscopy is a novel imaging technology, which allows real-time visualization and interpretation of microscopic details in live tissues. Although several potential uses have been identified for this technology, no data are available regarding its real-world uses. We report the results of an email-based survey of experts in North America regarding their use of the technology.
    Keywords Confocal laser endomicroscopy ; Expert opinion ; Diseases of the digestive system. Gastroenterology ; RC799-869 ; Specialties of internal medicine ; RC581-951 ; Internal medicine ; RC31-1245 ; Medicine ; R ; DOAJ:Gastroenterology ; DOAJ:Medicine (General) ; DOAJ:Health Sciences
    Language English
    Publishing date 2011-01-01T00:00:00Z
    Publisher Baishideng Publishing Group Co., Limited
    Document type Article ; Online
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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