Publications by authors named "Srihari Mahadev"

Purpose: Endoscopic sleeve gastroplasty (ESG) and GLP-1RA are proven obesity interventions with potential to aid patients who have MASLD. However, their comparative effectiveness remains unclear. This study aimed to compare ESG and semaglutide in MASLD patients regarding weight loss and improvements in metabolic parameters, including liver enzymes, and FIB-4 scores.

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Introduction: The rising prevalence of obesity and demand for minimally invasive treatments has led to increased adoption of endoscopic sleeve gastroplasty (ESG). As telemedicine expands in bariatrics, understanding the role of virtual follow-up care is crucial. This study aims to use propensity-matching to compare weight loss and metabolic outcomes between virtual and in-person follow-up modalities post-ESG.

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Background And Aims: Salvage endoscopic submucosal dissection (ESD) has been proposed for previously attempted colorectal lesions (PACLs), yet the extensive submucosal fibrosis impacts procedural difficulty and resection outcomes. The aim of this study was to evaluate the efficacy and safety of salvage ESD for the treatment of PACLs.

Methods: This international, multicenter study enrolled consecutive patients who underwent ESD to manage PACLs.

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Background And Aims: Prior data have shown that specimen quality deteriorates when 22-gauge needles are used in place of 19-gauge needles during EUS-guided liver biopsy (EUS-LB). Emerging data suggest that a novel hydrostatic sampling technique (HST) may offer improved performance over wet suction (WS). We hypothesized that EUS-LB using a 22-gauge fine-needle biopsy needle with the HST would attain tissue adequacy similar to that of 19-gauge needles.

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Background: Endoscopic sleeve gastroplasty (ESG) is an incisionless weight loss procedure that has been demonstrated to be safe and effective for the treatment of obesity; however, the efficacy of ESG for the treatment of comorbid type 2 diabetes mellitus (T2DM) and other components of metabolic syndrome (MetS) has been less well studied. We aimed to conduct a systematic review and meta-analysis of available literature to evaluate the outcomes of ESG on T2DM and MetS.

Methods: Bibliographic databases were systematically searched for studies assessing the outcomes of ESG on T2DM and MetS.

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Background And Aims: Glucagon-like peptide-1 receptor agonists (GLP-1RAs) are used for type 2 diabetes mellitus and obesity, but safety concerns have been raised for users undergoing GI endoscopy because of retained food and aspiration events. We compared the risk of adverse events for GLP-1RA users and nonusers undergoing endoscopy.

Methods: We conducted a systematic review and meta-analysis (PROSPERO registration: CRD42024556732).

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Background And Aims: Endoscopic sleeve gastroplasty (ESG) is a minimally invasive bariatric procedure of the gastric cavity to facilitate weight loss. We aimed to evaluate the long-term effects of ESG as a monotherapy on obesity-related comorbidities over 5 years.

Methods: This prospective study analyzed data from 404 consecutive patients (aged 45 ± 11.

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Purpose: Rising obesity and type 2 diabetes mellitus (T2DM) rates can be mitigated by various strategies, with a 10% total body weight loss (TBWL) threshold often required for T2DM remission. T2DM remission rates after bariatric surgery like Roux-en-Y gastric bypass (RYGB) are well established; endoscopic sleeve gastroplasty (ESG) is a less invasive option that averages 15% TBWL and allows for T2DM remission. This study explores the DiaRem (Diabetes Remission post-RYGB) score's ability to predict T2DM remission 1-year post-ESG.

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Objective: Endoscopic retrograde cholangiopancreatography (ERCP) may be unsuccessful in patients with duodenal stenosis or malignant ampullary infiltration. Endoscopic ultrasound-guided biliary drainage (EUS-BD) has been proposed as an alternative. We aimed to assess the efficacy and safety of EUS-BD for malignant distal bile duct obstruction using the newly introduced smaller caliber 6 or 8 mm cautery-enhanced lumen-apposing metal stent.

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Article Synopsis
  • EUS-FNA is a technique used for assessing pancreatic cysts, with an emphasis on determining the risk of pancreatitis, a common complication, to improve clinical decision-making.
  • A systematic review analyzed 64 studies involving over 8,000 patients, finding that the risk of pancreatitis from EUS-FNA is low at about 1.4% and typically mild.
  • Recent trends suggest that certain factors, like the type of needle used and the method of biopsy, might influence the risk, indicating a need for more research in this area.
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Background And Aims: The application of endoscopic suturing has revolutionized defect closures. Conventional over-the-scope suturing necessitates removal of the scope, placement of the device, and reinsertion. A single channel, single sequence, through-the-scope suturing device has been developed to improve this process.

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Background: Endoscopic ultrasound-guided fine needle biopsy (EUS-FNB) is frequently used to obtain core samples of solid lesions. Here, we describe and evaluate a novel hydrostatic stylet (HS) technique designed to optimize core sample acquisition, reporting diagnostic yield, efficacy, and safety relative to the conventional stylet slow-pull (SP) technique.

Methods: A novel HS technique was developed and validated retrospectively.

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Endoscopic ultrasound-guided gastroenterostomy (EUS-GE) is an emerging procedure that lacks technical standardization with limited adoption beyond expert centers. We surveyed high-volume endosonographers about the technical aspects of EUS-GE to describe how the procedure is currently performed at expert centers and identify targets for standardization. Invitations to complete an electronic survey were distributed to 21 expert EUS practitioners at 19 U.

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Background And Aims: No studies have evaluated trainees' outcomes when learning ERCP with patients in the supine and prone positions simultaneously. We aimed to assess whether patient position impacts procedural outcomes and learning curve.

Methods: We prospectively evaluated patients undergoing ERCP by a supervised advanced endoscopy trainee (AET) at a tertiary care center.

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Video 1Presentation and treatment of an unusual acute worsening of gastric outlet obstruction following EUS-guided gastrojejunal bypass.

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Background And Aims: Palliation of malignant gastric outlet obstruction (mGOO) allows resumption of peroral intake. Although surgical gastrojejunostomy (SGJ) provides durable relief, it may be associated with a higher morbidity, interfere with chemotherapy, and require an optimum nutritional status. EUS-guided gastroenterostomy (EUS-GE) has emerged as a minimally invasive alternative.

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Background And Aims: Interventions for malignant small-bowel obstruction (SBO) may be limited by extent of peritoneal disease, rendering surgical or traditional endoscopic methods (ie, luminal stenting or decompressive gastrostomy) unfeasible. We demonstrated the novel use of EUS-guided lumen-apposing metal stent placement for enterocolonic bypass in patients with malignant SBO who were deemed high risk for surgery.

Methods: Across 3 tertiary U.

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Article Synopsis
  • Endoscopic ultrasound-guided gallbladder drainage with lumen-apposing metal stents is a viable treatment for acute cholecystitis in patients who can't undergo surgery.
  • A case study of an 83-year-old male illustrates that a coaxial double-pigtail stent, while intended to prevent bleeding, led to a duodenal ulcer causing upper gastrointestinal bleeding.
  • Replacing the original stent with two more flexible 7-Fr stents improved the patient's condition, suggesting that flexible stents may be better for delicate structures like the duodenum despite the common preference for stiffer 10-Fr stents.
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