Role of gastric per-oral endoscopic myotomy (G-POEM) in post-lung transplant patients: a multicenter experience

Background and study aims: Gastroparesis post-lung transplant (LTx) can lead to increased risk of gastroesophageal reflux (GER) and accelerated graft dysfunction. We aimed to evaluate the efficacy and safety of gastric per-oral endoscopic myotomy (G-POEM), a promising tool in patients with refractory gastroparesis, for managing refractory gastroparesis and GER in post-LTx patients. Patents and methods  This was a multicenter retrospective study on post-LTx patients who underwent G-POEM for management of gastroparesis and GER that were refractory to standard medical therapy. The primary outcome was clinical success post-G-POEM. Secondary outcomes included the rate of post-G-POEM objective esophageal pH exam normalization, rate of gastric emptying scintigraphy (GES) normalization, technical success, and adverse events. Results: A total of 20 patients (mean age 54.7 ± 14.1 years, Female 50 %) underwent G-POEM at a median time of 13 months (interquartile range 6.5-13.5) post-LTx. All G-POEM procedures were technically successful. Clinical success was achieved in 17 (85 %) patients during a median follow-up time of 8.9 (IQR: 3-17) months post-G-POEM. Overall GCSI and two of its subscales (bloating and postprandial fullness/early satiety) improved significantly following G-POEM. Two patients (10 %) developed post-procedural AEs (delayed bleeding 1, pyloric stenosis 1, both moderate in severity). Post-G-POEM GES improvement was achieved in 12 of 16 patients (75 %). All 20 patients were on proton pump inhibitors pre-G-POEM, as opposed to five post-G-POEM. Post-G-POEM PH study normalization was noted in nine of 10 patients (90 %) who underwent both pre- and post-G-poem pH testing. Conclusions: G-POEM is a promising noninvasive therapeutic tool for management of refractory gastroparesis and GER post-LTx

An international experience with single-operator cholangiopancreatoscopy in patients with altered anatomy

Background and study aims: The utility of digital single- operator cholangiopancreatoscopy (D-SOCP) in surgically altered anatomy (SAA) is limited. We aimed to evaluate the technical success and safety of D-SOCP in patients SAA. Patients and methods: Patients with SAA who underwent D-SOCP between February 2015 and June 2020 were retrospectively evaluated. Technical success was defined as completing the intended procedure with the use of D-SOCP. Results: Thirty-five patients underwent D-SOCP (34 D-SOC, 1 D-SOP). Bilroth II was the most common type of SAA (45.7 %), followed by Whipple reconstruction (31.4 %). Twenty-three patients (65.7 %) patients had prior failed ERCP due to the presence of complex biliary stone (52.2 %). A therapeutic duodenoscope was utilized in the majority of the cases (68.6 %), while a therapeutic gastroscope (22.7 %) or adult colonoscope (8.5 %) were used in the remaining procedures. Choledocholithiasis (61.2 %) and pancreatic duct calculi (3.2 %) were the most common indications for D-SOCP. Technical success was achieved in all 35 patients (100 %) and majority (91.4 %) requiring a single session. Complex interventions included electrohydraulic or laser lithotripsy, biliary or pancreatic stent placement, stricture dilation, and target tissue biopsies. Two mild adverse events occurred (pancreatitis and transient bacteremia). Conclusions: In SAA, D-SOCP is a safe and effective modality to diagnose and treat complex pancreatobiliary disorders, especially in cases where standard ERCP attempts may fail

Molecular Signatures of the Different Types of Hyperlipidemia According to the Fredrickson Classification

Hyperlipidemia, characterized by abnormally high levels of lipoproteins in the plasma, is one of the biggest epidemics facing our healthcare system today. The Center for Disease Control and Prevention (CDC) estimates that about one-third of American adults have some form of hyperlipidemia and that of those, only one-third are well-managed. With the growing obesity problem in America and the significant, detrimental health effects that hyperlipidemia can cause, developing new, more effective tools to help prevent, diagnose and treat hyperlipidemias is an urgent matter of public health. Hyperlipidemias can be classified into three main categories: Primary (familial) caused by specific genetic abnormalities, secondary (acquired) abnormal plasma lipoprotein concentrations due to another underlying disorder, or idiopathic elevated lipoprotein. All three forms can almost double the risk of developing cardiovascular disease, the leading cause of death in the United States, and thus for decades scientists have sought to research, organize and understand how the chronic elevation of these lipoproteins in the blood circulation influence the human body. However, recently, researchers have begun to question the clinical usefulness of one of the most widely used hyperlipidemia classification models which first originated in 1967 and adopted by the World Health Organization, the Fredrickson familial hyperlipidemia classification. This classification is based on the pattern of lipoproteins in the plasma, which was resolved by physical analytic techniques, and includes five categories. Although Fredrickson’s model was instrumental in the original understanding of familial hyperlipidemias, this classification is not based on molecular causes of hyperlipidemias and therefore it has limitations in its clinical use, especially in the era of precision medicine. Thus, the objective of this project was to conduct a comprehensive literature review of the published biomedical literature for molecular defects in patients with different types of familial hyperlipidemias. Using this knowledge, we sought to better understand how molecular mechanisms govern elevated lipoproteins and then to subsequently integrate this information into the previously established Fredrickson classification. Our hope is that with this project, along with further research in the future, we are one day able to produce a more useful clinical tool which will provide a better explanation for hyperlipidemias and lead to better patient treatments