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Endoscopic versus surgical management for colonic volvulus hospitalizations in the United States
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Dushyant Singh Dahiya, Abhilash Perisetti, Hemant Goyal, Sumant Inamdar, Amandeep Singh, Rajat Garg, Chin-I Cheng, Mohammad Al-Haddad, Madhusudhan R. Sanaka, Neil Sharma
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Clin Endosc 2023;56(3):340-352. Published online April 17, 2023
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DOI: https://doi.org/10.5946/ce.2022.166
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Graphical Abstract
Abstract
PDFPubReaderePub
- Background
/Aims: Colonic volvulus (CV), a common cause of bowel obstruction, often requires intervention. We aimed to identify hospitalization trends and CV outcomes in the United States.
Methods We used the National Inpatient Sample to identify all adult CV hospitalizations in the United States from 2007 to 2017. Patient demographics, comorbidities, and inpatient outcomes were highlighted. Outcomes of endoscopic and surgical management were compared.
Results From 2007 to 2017, there were 220,666 CV hospitalizations. CV-related hospitalizations increased from 17,888 in 2007 to 21,715 in 2017 (p=0.001). However, inpatient mortality decreased from 7.6% in 2007 to 6.2% in 2017 (p<0.001). Of all CV-related hospitalizations, 13,745 underwent endoscopic intervention, and 77,157 underwent surgery. Although the endoscopic cohort had patients with a higher Charlson comorbidity index, we noted lower inpatient mortality (6.1% vs. 7.0%, p<0.001), mean length of stay (8.3 vs. 11.8 days, p<0.001), and mean total healthcare charge ($68,126 vs. $106,703, p<0.001) compared to the surgical cohort. Male sex, increased Charlson comorbidity index scores, acute kidney injury, and malnutrition were associated with higher odds of inpatient mortality in patients with CV who underwent endoscopic management.
Conclusions Endoscopic intervention has lower inpatient mortality and is an excellent alternative to surgery for appropriately selected CV hospitalizations.
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Citations
Citations to this article as recorded by
- Colonic Volvulus
Samantha L. Savitch, Calista M. Harbaugh Clinics in Colon and Rectal Surgery.2024; 37(06): 398. CrossRef - Navigating Abdominal Volvulus: A Comprehensive Review of Management Strategies
Simran Chauhan, Raju K Shinde, Yashraj Jain Cureus.2024;[Epub] CrossRef - Clinicopathological Features of Elderly Patients with Colonic Volvulus
Mehmet Onur Gul, Selda Oğuz Aşlayan, Kadir Çorbacı, Aytaç Selman, Emre Berat Akçay, Oğuzhan Sunamak, Cebrail Akyüz European Journal of Therapeutics.2024; 30(3): 303. CrossRef - Incidental Sigmoid Volvulus after a Ground-level Fall: An Unusual Case Report
Ziya Karimov, Elchin Shirinov, Gunay Huseynova, Mirhuseyn Mammadov, Meltem Songür Kodik Caucasian Medical Journal.2023; 1(3): 36. CrossRef
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Peroral endoscopic myotomy versus Heller’s myotomy for achalasia hospitalizations in the United States: what does the future hold?
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Dushyant Singh Dahiya, Vinay Jahagirdar, Manesh Kumar Gangwani, Muhammad Aziz, Chin-I Cheng, Sumant Inamdar, Madhusudhan R. Sanaka, Mohammad Al-Haddad
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Clin Endosc 2022;55(6):826-828. Published online November 3, 2022
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DOI: https://doi.org/10.5946/ce.2022.283
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PDFPubReaderePub
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IgG4 Levels in Bile for Distinguishing IgG4-Associated Cholangiopathy from Other Biliary Disorders: A Single Blinded Pilot Study
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Udayakumar Navaneethan, Norma G. Gutierrez, Ramprasad Jegadeesan, Preethi GK Venkatesh, Earl Poptic, Madhusudhan R. Sanaka, John J. Vargo, Mansour A. Parsi
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Clin Endosc 2014;47(6):555-559. Published online November 30, 2014
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DOI: https://doi.org/10.5946/ce.2014.47.6.555
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Abstract
PDFPubReaderePub
- Background/Aims
Immunoglobulin G4 (IgG4)-associated cholangiopathy (IAC) is an inflammatory disease and may mimic primary sclerosing cholangitis (PSC), cholangiocarcinoma (CCA), or pancreatic cancer on cholangiography. We investigated whether IgG4 levels in bile aspirated during endoscopic retrograde cholangiopancreatography (ERCP) can distinguish IAC from PSC, CCA, and pancreatic cancer. MethodsBile was aspirated directly from the common bile duct during ERCP in patients with IAC prior to steroid therapy. For control purposes, bile was obtained from patients with PSC, CCA, pancreatic cancer, and benign biliary conditions (sphincter of oddi dysfunction/choledocholithiasis). ResultsBiliary IgG4 levels were measured in 54 patients. The median bile IgG4 levels were markedly elevated in patients with IAC (5.5 mg/dL; interquartile range [IQR], 5.1 to 15.6) as compared to patients with benign biliary conditions (0 mg/dL; IQR, 0 to 0.1; p=0.003). The median biliary IgG4 levels in PSC, CCA, and pancreatic cancer were 1.2 (IQR, 0.2 to 3.8), 0.9 (IQR, 0.2 to 3.4), and 0.2 mg/dL (IQR, 0.1 to 0.8), respectively. A cutoff value of 3.8 mg/dL distinguished IAC from PSC and CCA patients with 100% and 76.9% sensitivity and specificity, respectively. ConclusionsThe results of this pilot study suggest that measurement of biliary IgG4 levels may have clinical value in distinguishing patients with IAC from biliary disorders that can mimic IAC.
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Citations
Citations to this article as recorded by
- Clinical Features, Differential Diagnosis and Treatment of IgG4-Related Sclerosing Cholangitis
A. K. Guseva, A. V. Okhlobystin The Russian Archives of Internal Medicine.2024; 14(2): 96. CrossRef - Review of primary sclerosing cholangitis with increased IgG4 levels
Charis D Manganis, Roger W Chapman, Emma L Culver World Journal of Gastroenterology.2020; 26(23): 3126. CrossRef - Immunoglobulin G4-related cholangiopathy
Lucas J. Maillette de Buy Wenniger, Ulrich Beuers Current Opinion in Gastroenterology.2015; 31(3): 252. CrossRef - Diagnosis of Immunoglobulin G4-Related Sclerosing Cholangitis
Ji Kon Ryu Clinical Endoscopy.2014; 47(6): 476. CrossRef
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