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  1. AU="Dewitt, John M"
  2. AU="Sorin M. Dudea"
  3. AU="Tanusha D. Ramdin"
  4. AU="Hao, Zehui"
  5. AU="Chauhan, Aman"

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  1. Article ; Online: Characterization of endoscopic features and histology of a distinct mucosal transition zone on the ileocecal valve (with video).

    Rex, Douglas K / Lahr, Rachel E / Guardiola, John J / Dewitt, John M / Zhang, Dongwei

    Gastrointestinal endoscopy

    2023  Volume 98, Issue 3, Page(s) 400–404

    Abstract: Background and aims: We have endoscopically encountered a zone of transitional mucosa between the colonic and ileal mucosa located in a 3- to 10-mm-wide ring around the ileocecal valve (ICV) orifice. We aimed to describe the features of the ICV ... ...

    Abstract Background and aims: We have endoscopically encountered a zone of transitional mucosa between the colonic and ileal mucosa located in a 3- to 10-mm-wide ring around the ileocecal valve (ICV) orifice. We aimed to describe the features of the ICV transitional zone mucosa.
    Methods: We used videos and photographs from normal ICVs and biopsy samples from normal colonic mucosa, transitional zone mucosa, and normal ileal mucosa to characterize the endoscopic and histologic features of the ICV transitional zone mucosa.
    Results: The ICV transitional zone is identifiable on every ICV without a circumferential adenoma or inflammation that obliterates the zone. The zone is characterized endoscopically by an absence of villi, which distinguishes it from the ileal mucosa, but the pits are more tubular and with more prominent blood vessels compared with normal colonic mucosa. Histologically, the villi of the transitional zone are blunted, and the amount of lymphoid tissue is intermediate between the colonic mucosa and ileal mucosa.
    Conclusions: This is the first description of the normal transitional zone of mucosa on the ICV. This zone has unique endoscopic features that should be recognized by colonoscopists and that can potentially create difficulty in identifying the margins of adenomas located on the ICV.
    MeSH term(s) Humans ; Ileocecal Valve ; Ileum/pathology ; Colon/pathology ; Cecum ; Intestinal Mucosa/pathology ; Adenoma/pathology
    Language English
    Publishing date 2023-03-31
    Publishing country United States
    Document type Video-Audio Media ; Journal Article
    ZDB-ID 391583-9
    ISSN 1097-6779 ; 0016-5107
    ISSN (online) 1097-6779
    ISSN 0016-5107
    DOI 10.1016/j.gie.2023.03.021
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  2. Article ; Online: Response.

    Khashab, Mouen A / Dewitt, John M

    Gastrointestinal endoscopy

    2016  Volume 84, Issue 5, Page(s) 878

    Language English
    Publishing date 2016
    Publishing country United States
    Document type Letter ; Comment
    ZDB-ID 391583-9
    ISSN 1097-6779 ; 0016-5107
    ISSN (online) 1097-6779
    ISSN 0016-5107
    DOI 10.1016/j.gie.2016.06.040
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  3. Article ; Online: Tumor Seeding Associated With Selected Gastrointestinal Endoscopic Interventions.

    Gleeson, Ferga C / Lee, Jeffrey H / Dewitt, John M

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

    2018  Volume 16, Issue 9, Page(s) 1385–1388

    MeSH term(s) Endoscopy, Gastrointestinal/adverse effects ; Endoscopy, Gastrointestinal/methods ; Humans ; Neoplasm Seeding
    Language English
    Publishing date 2018-05-17
    Publishing country United States
    Document type Journal Article ; Review
    ZDB-ID 2119789-1
    ISSN 1542-7714 ; 1542-3565
    ISSN (online) 1542-7714
    ISSN 1542-3565
    DOI 10.1016/j.cgh.2018.05.014
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  4. Article ; Online: Colorectal endoscopic submucosal dissection in the United States: Why do we hear so much about it and do so little of it?

    Rex, Douglas K / Hassan, Cesare / Dewitt, John M

    Gastrointestinal endoscopy

    2017  Volume 85, Issue 3, Page(s) 554–558

    MeSH term(s) Colonoscopy ; Colorectal Neoplasms ; Dissection ; Endoscopic Mucosal Resection ; Humans ; United States
    Language English
    Publishing date 2017
    Publishing country United States
    Document type Editorial
    ZDB-ID 391583-9
    ISSN 1097-6779 ; 0016-5107
    ISSN (online) 1097-6779
    ISSN 0016-5107
    DOI 10.1016/j.gie.2016.09.015
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  5. Article ; Online: EUS-guided fine needle aspiration-based clues to mistaken or uncertain identity: serous pancreatic cysts.

    Yip-Schneider, Michele T / Muraru, Rodica / Kim, Rachel C / Wu, Howard H / Sherman, Stuart / Gutta, Aditya / Al-Haddad, Mohammad A / Dewitt, John M / Schmidt, C Max

    HPB : the official journal of the International Hepato Pancreato Biliary Association

    2023  Volume 25, Issue 12, Page(s) 1587–1594

    Abstract: Background/objectives: Pancreatic serous cystic neoplasms (SCN) present a diagnostic challenge given their increasing frequency of detection and benign nature yet relatively high rate of misdiagnosis. Here, imaging and analyses associated with EUS- ... ...

    Abstract Background/objectives: Pancreatic serous cystic neoplasms (SCN) present a diagnostic challenge given their increasing frequency of detection and benign nature yet relatively high rate of misdiagnosis. Here, imaging and analyses associated with EUS-guided fine-needle aspiration (EUS-FNA) are evaluated for their ability to provide a correct preoperative diagnosis of SCN.
    Methods: A surgical cohort with confirmed pathological diagnosis of SCN (n = 62) and a surveillance cohort with likely SCN (n = 31) were assessed for imaging (CT/MRI/EUS) and EUS-FNA-based analyses (cytology/DNA analysis for Von Hippel-Lindau [VHL] gene alterations/biomarkers).
    Results: In the surgical cohort, CT/MRI and EUS respectively predicted SCN in 4 of 58(7%) and 19 of 62(31%). Cyst fluid cytology and VHL alterations predicted SCN in 1 of 51(2%) and 5 of 21(24%), respectively. High specificity cyst fluid biomarkers (vascular endothelial growth factor [VEGF]/glucose/carcinoembryonic antigen [CEA]/amylase) correctly identified SCN in 25 of 27(93%). In the surveillance cohort, cyst fluid biomarkers predicted SCN in 12 of 12(100%) while VHL alterations identified SCN 3 of 10(30%).
    Conclusion: High specificity cyst fluid biomarkers provided the most sensitive means of diagnosing SCN preoperatively. To obtain a preoperative diagnosis of SCN at the highest level of certainty, a multidisciplinary approach should be taken to inform appropriate SCN management.
    MeSH term(s) Humans ; Biopsy, Fine-Needle ; Vascular Endothelial Growth Factor A ; Carcinoembryonic Antigen ; Pancreatic Cyst/diagnostic imaging ; Pancreatic Cyst/genetics ; Endosonography ; Pancreatic Neoplasms/diagnostic imaging ; Pancreatic Neoplasms/genetics ; Endoscopic Ultrasound-Guided Fine Needle Aspiration
    Chemical Substances Vascular Endothelial Growth Factor A ; Carcinoembryonic Antigen
    Language English
    Publishing date 2023-09-09
    Publishing country England
    Document type Journal Article
    ZDB-ID 2131251-5
    ISSN 1477-2574 ; 1365-182X
    ISSN (online) 1477-2574
    ISSN 1365-182X
    DOI 10.1016/j.hpb.2023.09.009
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  6. Article ; Online: Factors predictive of hospital length of stay in patients with an index episode of acute necrotizing pancreatitis.

    Obaitan, Itegbemie / Wehbe, Hisham / Easler, Jeffrey J / Stethen, Joseph T / Mahendraker, Neetu / Tong, Yan / Vargas, Alejandra / Dewitt, John M / Bick, Benjamin L / Fogel, Evan / Gutta, Aditya / Sherman, Stuart / Watkins, James / Gromski, Mark / Saleem, Nasir / Zyromski, Nicholas / Al-Haddad, Mohammad A

    Pancreatology : official journal of the International Association of Pancreatology (IAP) ... [et al.

    2023  Volume 24, Issue 1, Page(s) 32–40

    Abstract: Introduction: Acute necrotizing pancreatitis (ANP) complicates 15 % of acute pancreatitis cases and is associated with prolonged length of stay (LOS). There are limited studies exploring potential predictors.: Methods: We carried out a retrospective ... ...

    Abstract Introduction: Acute necrotizing pancreatitis (ANP) complicates 15 % of acute pancreatitis cases and is associated with prolonged length of stay (LOS). There are limited studies exploring potential predictors.
    Methods: We carried out a retrospective study of all consecutive patients presenting to a large referral healthcare system with ANP. Patients younger than 18 years of age, without confirmed glandular necrosis and with in-hospital mortality were excluded. Poisson regression was carried out to identify potential predictors of prolonged hospital stay.
    Results: One hundred and sixty-two patients hospitalized between December 2016 and June 2020 were included. The median LOS was 12 days (range: 1-155 days). On multivariate analysis, organ dysfunction at presentation (Incidence rate ratio (IRR) 1.21, p = 0.01) or during admission (IRR 1.32, p = 0.001), Charlson Comorbidity Index scores (IRR 1.1 per CCI point, p < 0.001), known chronic pancreatitis (IRR 1.19, p = 0.03), concurrent (non-pancreas related) infections (IRR 1.13, p = 0.04), need for enteral tube placement (IRR 3.42, p < 0.001) and in-hospital interventions (IRR 1.48-2.85 depending on intervention, p < 0.001) were associated with increased LOS. For patients in the cohort to whom this applied, delayed hospital transfers (IRR 1.02, p < 0.001) and delayed start of enteral feeds (IRR 1.01, p = 0.017) contributed to increased overall LOS.
    Conclusion: We demonstrate that multiple factors including delayed transfers to hospitals with pancreaticobiliary expertise lead to increased length of hospitalization. We suggest various strategies that can be considered to target those gaps and may have a favorable effect on LOS.
    MeSH term(s) Humans ; Length of Stay ; Pancreatitis, Acute Necrotizing ; Retrospective Studies ; Acute Disease ; Hospitals
    Language English
    Publishing date 2023-11-17
    Publishing country Switzerland
    Document type Journal Article
    ZDB-ID 2056680-3
    ISSN 1424-3911 ; 1424-3903
    ISSN (online) 1424-3911
    ISSN 1424-3903
    DOI 10.1016/j.pan.2023.11.008
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  7. Article ; Online: Confocal Endomicroscopy Characteristics of Different Intraductal Papillary Mucinous Neoplasm Subtypes.

    Kamboj, Amrit K / Dewitt, John M / Modi, Rohan M / Conwell, Darwin L / Krishna, Somashekar G

    JOP : Journal of the pancreas

    2017  Volume 18, Issue Suppl 2, Page(s) 198–202

    Abstract: Intraductal papillary mucinous neoplasms are classified into gastric, intestinal, pancreatobiliary, and oncocytic subtypes where morphology portends disease prognosis. The study aim was to demonstrate EUS-guided needle-based confocal laser endomicroscopy ...

    Abstract Intraductal papillary mucinous neoplasms are classified into gastric, intestinal, pancreatobiliary, and oncocytic subtypes where morphology portends disease prognosis. The study aim was to demonstrate EUS-guided needle-based confocal laser endomicroscopy imaging features of intraductal papillary mucinous neoplasm subtypes. Four subjects, each with a specific intraductal papillary mucinous neoplasm subtype were enrolled. An EUS-guided needle-based confocal laser endomicroscopy miniprobe was utilized for image acquisition. The mean cyst size from the 4 subjects (2 females; mean age = 65.3±12 years) was 36.8±12 mm. All lesions demonstrated mural nodules and focal dilation of the main pancreatic duct. EUS-nCLE demonstrated characteristic finger-like papillae with inner vascular core for all subtypes. The image patterns of the papillae for the gastric, intestinal, and pancreatobiliary subtypes were similar. However, the papillae in the oncocytic subtype were thick and demonstrated a fine scale-like or honeycomb pattern with intraepithelial lumina correlating with histopathology. There was significant overlap in the needle-based confocal laser endomicroscopy findings for the different intraductal papillary mucinous neoplasm subtypes; however, the oncocytic subtype demonstrated distinct patterns. These findings need to be replicated in larger multicenter studies.
    Language English
    Publishing date 2017-08-05
    Publishing country Italy
    Document type Journal Article
    ZDB-ID 2039637-5
    ISSN 1590-8577 ; 1590-8577
    ISSN (online) 1590-8577
    ISSN 1590-8577
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  8. Article ; Online: Biomarker Risk Score Algorithm and Preoperative Stratification of Patients with Pancreatic Cystic Lesions.

    Yip-Schneider, Michele T / Wu, Huangbing / Allison, Hannah R / Easler, Jeffrey J / Sherman, Stuart / Al-Haddad, Mohammad A / Dewitt, John M / Schmidt, C Max

    Journal of the American College of Surgeons

    2021  Volume 233, Issue 3, Page(s) 426–434.e4

    Abstract: Background: Pancreatic cysts are incidentally detected in up to 13% of patients undergoing radiographic imaging. Of the most frequently encountered types, mucin-producing (mucinous) pancreatic cystic lesions may develop into pancreatic cancer, while ... ...

    Abstract Background: Pancreatic cysts are incidentally detected in up to 13% of patients undergoing radiographic imaging. Of the most frequently encountered types, mucin-producing (mucinous) pancreatic cystic lesions may develop into pancreatic cancer, while nonmucinous ones have little or no malignant potential. Accurate preoperative diagnosis is critical for optimal management, but has been difficult to achieve, resulting in unnecessary major surgery. Here, we aim to develop an algorithm based on biomarker risk scores to improve risk stratification.
    Study design: Patients undergoing surgery and/or surveillance for a pancreatic cystic lesion, with diagnostic imaging and banked pancreatic cyst fluid, were enrolled in the study after informed consent (n = 163 surgical, 67 surveillance). Cyst fluid biomarkers with high specificity for distinguishing nonmucinous from mucinous pancreatic cysts (vascular endothelial growth factor [VEGF], glucose, carcinoembryonic antigen [CEA], amylase, cytology, and DNA mutation) were selected. Biomarker risk scores were used to design an algorithm to predict preoperative diagnosis. Performance was tested using surgical (retrospective) and surveillance (prospective) cohorts.
    Results: In the surgical cohort, the biomarker algorithm outperformed the preoperative clinical diagnosis in correctly predicting the final pathologic diagnosis (91% vs 73%; p < 0.000001). Specifically, nonmucinous serous cystic neoplasms (SCN) and mucinous cystic neoplasms (MCN) were correctly classified more frequently by the algorithm than clinical diagnosis (96% vs 30%; p < 0.000008 and 92% vs 69%; p = 0.04, respectively). In the surveillance cohort, the algorithm predicted a preoperative diagnosis with high confidence based on a high biomarker score and/or consistency with imaging from ≥1 follow-up visits.
    Conclusions: A biomarker risk score-based algorithm was able to correctly classify pancreatic cysts preoperatively. Importantly, this tool may improve initial and dynamic risk stratification, reducing overdiagnosis and underdiagnosis.
    MeSH term(s) Adult ; Aged ; Algorithms ; Biomarkers, Tumor/analysis ; Female ; Humans ; Male ; Middle Aged ; Pancreatic Cyst/diagnosis ; Pancreatic Cyst/diagnostic imaging ; Pancreatic Cyst/surgery ; Pancreatic Neoplasms/diagnosis ; Pancreatic Neoplasms/diagnostic imaging ; Pancreatic Neoplasms/surgery ; Prospective Studies ; Retrospective Studies ; Risk Factors
    Chemical Substances Biomarkers, Tumor
    Language English
    Publishing date 2021-06-21
    Publishing country United States
    Document type Journal Article ; Research Support, N.I.H., Extramural ; Research Support, Non-U.S. Gov't
    ZDB-ID 1181115-8
    ISSN 1879-1190 ; 1072-7515
    ISSN (online) 1879-1190
    ISSN 1072-7515
    DOI 10.1016/j.jamcollsurg.2021.05.030
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  9. Article ; Online: Reply to letters, guidelines: acute pancreatitis.

    Tenner, Scott / Baillie, John / Dewitt, John M / Vege, Santhi Swaroop

    The American journal of gastroenterology

    2014  Volume 109, Issue 3, Page(s) 444

    MeSH term(s) Humans ; Pancreas/surgery ; Pancreatitis/surgery
    Language English
    Publishing date 2014-03
    Publishing country United States
    Document type Comment ; Letter
    ZDB-ID 390122-1
    ISSN 1572-0241 ; 0002-9270
    ISSN (online) 1572-0241
    ISSN 0002-9270
    DOI 10.1038/ajg.2013.474
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  10. Article ; Online: A Quantitative Global Proteomics Approach Identifies Candidate Urinary Biomarkers That Correlate With Intraductal Papillary Mucinous Neoplasm Dysplasia.

    Flick, Katelyn F / Yip-Schneider, Michele T / Sublette, Christopher M / Simpson, Rachel E / Colgate, Cameron L / Wu, Huangbing / Soufi, Mazhar / Dewitt, John M / Mosley, Amber L / Ceppa, Eugene P / Zhang, Jianjun / Schmidt, C Max

    Pancreas

    2020  Volume 49, Issue 8, Page(s) 1044–1051

    Abstract: Objectives: A proteomic discovery study was performed to determine if urine possesses a unique biosignature that could form the basis for a noninvasive test able to predict intraductal papillary mucinous neoplasm (IPMN) dysplasia.: Methods: Urine was ...

    Abstract Objectives: A proteomic discovery study was performed to determine if urine possesses a unique biosignature that could form the basis for a noninvasive test able to predict intraductal papillary mucinous neoplasm (IPMN) dysplasia.
    Methods: Urine was collected from patients undergoing surgery for IPMN (72 low/moderate, 27 high-grade/invasive). Quantitative mass spectrometry-based proteomics was performed. Proteins of interest were identified by differential expression analysis followed by principal component analysis.
    Results: Proteomics identified greater than 4800 urinary proteins. Low/moderate and high-grade/invasive IPMN were distinguished by 188 proteins (P < 0.05). Following principal component analysis and heatmap visualization, vitamin D binding protein (DBP), apolipoprotein A1 (APOA1), and alpha-1 antitrypsin (A1AT) were selected. The proteomic abundance of DBP (median [interquartile range]) was significantly higher for high-grade/invasive than for low/moderate IPMN (219,735 [128,882-269,943] vs. 112,295 [77,905-180,773] normalized reporter ion intensity units; P = 0.001). Similarly, APOA1 was more abundant in the high-grade/invasive than low/moderate groups (235,420 [144,933-371,247] vs 150,095 [103,419-236,591]; P = 0.0007) as was A1AT (567,514 [358,544-774,801] vs 358,393 [260,850-477,882]; P = 0.0006).
    Conclusions: Urinary DBP, APOA1, and A1AT represent potential biomarker candidates that may provide a noninvasive means of predicting IPMN dysplastic grade.
    MeSH term(s) Adenocarcinoma, Mucinous/metabolism ; Adenocarcinoma, Mucinous/surgery ; Aged ; Biomarkers, Tumor/metabolism ; Biomarkers, Tumor/urine ; Carcinoma, Pancreatic Ductal/metabolism ; Carcinoma, Pancreatic Ductal/surgery ; Carcinoma, Papillary/metabolism ; Carcinoma, Papillary/surgery ; Chromatography, Liquid/methods ; Cluster Analysis ; Female ; Humans ; Hyperplasia ; Male ; Middle Aged ; Pancreas/metabolism ; Pancreas/pathology ; Pancreas/surgery ; Pancreatic Neoplasms/metabolism ; Pancreatic Neoplasms/surgery ; Proteomics/methods ; Tandem Mass Spectrometry/methods
    Chemical Substances Biomarkers, Tumor
    Language English
    Publishing date 2020-08-07
    Publishing country United States
    Document type Journal Article ; Research Support, N.I.H., Extramural ; Research Support, Non-U.S. Gov't
    ZDB-ID 632831-3
    ISSN 1536-4828 ; 0885-3177
    ISSN (online) 1536-4828
    ISSN 0885-3177
    DOI 10.1097/MPA.0000000000001628
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