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Pancreatic Neoplasms: HELP
Articles by Vinay Chandrasekhara
Based on 8 articles published since 2009
(Why 8 articles?)
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Between 2009 and 2019, Vinay Chandrasekhara wrote the following 8 articles about Pancreatic Neoplasms.
 
+ Citations + Abstracts
1 Guideline The role of endoscopy in the diagnosis and treatment of cystic pancreatic neoplasms. 2016

Anonymous6580868 / Muthusamy, V Raman / Chandrasekhara, Vinay / Acosta, Ruben D / Bruining, David H / Chathadi, Krishnavel V / Eloubeidi, Mohamad A / Faulx, Ashley L / Fonkalsrud, Lisa / Gurudu, Suryakanth R / Khashab, Mouen A / Kothari, Shivangi / Lightdale, Jenifer R / Pasha, Shabana F / Saltzman, John R / Shaukat, Aasma / Wang, Amy / Yang, Julie / Cash, Brooks D / DeWitt, John M. · ·Gastrointest Endosc · Pubmed #27206409.

ABSTRACT: -- No abstract --

2 Guideline The role of endoscopy in the evaluation and management of patients with solid pancreatic neoplasia. 2016

Anonymous1760853 / Eloubeidi, Mohamad A / Decker, G Anton / Chandrasekhara, Vinay / Chathadi, Krishnavel V / Early, Dayna S / Evans, John A / Fanelli, Robert D / Fisher, Deborah A / Foley, Kimberly / Hwang, Joo Ha / Jue, Terry L / Lightdale, Jenifer R / Pasha, Shabana F / Saltzman, John R / Sharaf, Ravi / Shergill, Amandeep K / Cash, Brooks D / DeWitt, John M. · ·Gastrointest Endosc · Pubmed #26706297.

ABSTRACT: -- No abstract --

3 Review The Role of Endoscopic Retrograde Cholangiopancreatography in Management of Pancreatic Diseases. 2016

Riff, Brian P / Chandrasekhara, Vinay. ·Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1069, New York, NY 10029, USA. · Division of Gastroenterology, University of Pennsylvania Perelman School of Medicine, 3400 Civic Center Boulevard, Perelman Center for Advanced Medicine South Pavilion, 7th Floor, Philadelphia, PA 19104, USA. Electronic address: vinay.chandrasekhara@uphs.upenn.edu. ·Gastroenterol Clin North Am · Pubmed #26895680.

ABSTRACT: Endoscopic retrograde cholangiopancreatography is an effective platform for a variety of therapies in the management of benign and malignant disease of the pancreas. Over the last 50 years, endotherapy has evolved into the first-line therapy in the majority of acute and chronic inflammatory diseases of the pancreas. As this field advances, it is important that gastroenterologists maintain an adequate knowledge of procedure indication, maintain sufficient procedure volume to handle complex pancreatic endotherapy, and understand alternate approaches to pancreatic diseases including medical management, therapy guided by endoscopic ultrasonography, and surgical options.

4 Article Comparing American Gastroenterological Association Pancreatic Cyst Management Guidelines with Fukuoka Consensus Guidelines as Predictors of Advanced Neoplasia in Patients with Suspected Pancreatic Cystic Neoplasms. 2016

Ma, Gene K / Goldberg, David S / Thiruvengadam, Nikhil / Chandrasekhara, Vinay / Kochman, Michael L / Ginsberg, Gregory G / Vollmer, Charles M / Ahmad, Nuzhat A. ·Gastroenterology Division, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA. · Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA. · Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA. · Gastroenterology Division, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA. Electronic address: nuzhat.ahmad@uphs.upenn.edu. ·J Am Coll Surg · Pubmed #27497827.

ABSTRACT: BACKGROUND: In 2015, the American Gastroenterological Association (AGA) published guidelines to provide recommendations for management of suspected pancreatic cystic neoplasms (PCNs). The aim of this study was to compare efficacy of these with the Fukuoka consensus guidelines in predicting advanced neoplasia (AN) in patients with suspected PCNs. STUDY DESIGN: We performed a retrospective study of 239 patients who underwent surgical resection for suspected mucinous PCN at a tertiary care center from 2000 to 2014. Surgical pathology was the gold standard. The AGA and Fukuoka criteria were applied, and their performance in predicting AN, defined as invasive cancer or high-grade dysplasia (HGD), was assessed. RESULTS: Advanced neoplasia was found in 71 of 239 (29.7%) patients (28 invasive cancer, 43 HGD). The Fukuoka "high-risk" (FG-HR) and AGA "high-risk" (AGA-HR) criteria identified patients with AN with sensitivities of 28.2% and 35.2%, specificities of 95.8% and 94.0%, positive predictive values of 74.1% and 71.4%, and negative predictive values of 75.9% and 77.5%, respectively. Overall, there was no significant difference between the guidelines for prediction of AN. There were 7 and 6 cases with invasive cancer, and 23 and 24 cases with HGD missed by the FG-HR and AGA-HR guidelines, respectively. CONCLUSIONS: In a retrospective analysis, the AGA guidelines are not superior to the Fukuoka guidelines in identifying AN in suspected PCNs. Both sets of guidelines have fair PPV for detection of AN, which would lead to avoidable resections in patients without AN. Additionally, the high-risk features of both guidelines do not accurately identify all patients with AN.

5 Article Chronic immunosuppression does not potentiate the malignant progression of mucinous pancreatic cystic lesions. 2016

Agarwal, Amol / Scott, Frank I / Ahmad, Nuzhat A / Chandrasekhara, Vinay. ·Division of Gastroenterology, University of Pennsylvania Perelman School of Medicine, United States. · Division of Gastroenterology, University of Pennsylvania Perelman School of Medicine, United States. Electronic address: Vinay.Chandrasekhara@uphs.upenn.edu. ·Pancreatology · Pubmed #27424477.

ABSTRACT: BACKGROUND: Premalignant mucinous pancreatic cystic lesions (mPCLs) are increasingly identified. AIMS: In this study, we aim to assess the effect of selected immunosuppressive therapies on the progression of mPCLs, including side-branch intraductal papillary mucinous neoplasms and mucinous cystic neoplasms. METHODS: We performed a retrospective cohort study of patients with mPCLs diagnosed over a 24-year period who received chronic immunosuppression. Controls were matched on age at cyst diagnosis (±11 yrs) and cyst size (±8 mm). Measured outcomes included increase in cyst size, development of "worrisome features" as defined by consensus guidelines, progression to malignancy, and rate of surgical resection. RESULTS: 39 patients (mean age 60 yrs) with mPCLs were on immunosuppression. Leading indications for immunosuppression were solid organ transplant (n = 14), inflammatory bowel disease (n = 6), and rheumatoid arthritis (n = 5). 33% were on biologics, 77% on antimetabolites and 79% on multiple medications. Mean cyst size increased from 12.6 mm to 17.8 mm over a median of 16.5 months. 6 patients elected for surgical resection, and none ultimately developed malignancy. 26 cases with follow-up were matched to control subjects, with no significant differences among cases and controls in initial cyst size (12.8 mm vs 11.9 mm, P = 0.69), mean size increase (6.9 mm vs 5 mm, P = 0.47), follow-up interval (24.3 months vs 21.5 months, P = 0.44). No significant differences in the rate of worrisome features, malignancy, or surgical resection. CONCLUSIONS: Patients with mPCLs exposed to immunosuppressive medications did not have higher rates of malignancy or development worrisome features in the short term. This suggests that patients with mPCLs can be initiated or maintained on these agents without changes to surveillance practices.

6 Article Analysis of cyst size and tumor markers in the management of pancreatic cysts: support for the original Sendai criteria. 2015

Hoffman, Rebecca L / Gates, Jenna L / Kochman, Michael L / Ginsberg, Gregory G / Ahmad, Nuzhat A / Chandrasekhara, Vinay / Furth, Emma E / Vollmer, Charles M / Drebin, Jeffrey A. ·Department of Surgery, Hospital of the University of Pennsylvania Health System, Philadelphia, PA. Electronic address: Rebecca.hoffman@uphs.upenn.edu. · Department of Surgery, Hospital of the University of Pennsylvania Health System, Philadelphia, PA. · Department of Gastroenterology, Hospital of the University of Pennsylvania Health System, Philadelphia, PA. · Pathology and Laboratory Medicine, Anatomic Pathology Division, Hospital of the University of Pennsylvania Health System, Philadelphia, PA. ·J Am Coll Surg · Pubmed #25868415.

ABSTRACT: BACKGROUND: In 2006, the Sendai Consensus Guidelines identified size >3.0 cm as the only independent predictor of malignancy in incidentally discovered pancreatic cysts. The 2012 updated guidelines increased emphasis on radiographic features over size. Earlier studies included patients with preoperatively diagnosed carcinoma or with a corresponding mass. In this report, we characterize the use of size and serum tumor markers in the initial evaluation of pancreatic cystic neoplasms without preoperatively diagnosed adenocarcinoma and correlate them with clinical and pathologic outcomes. STUDY DESIGN: A retrospective cohort study was undertaken of 112 patients with a resected pancreatic cystic neoplasm. Patient demographics, cyst characteristics, preoperative serum tumor markers, morbidity, and mortality were captured. Statistical analysis included nonparametric tests of comparison, multivariate logistic regression, and receiver operating characteristic curve analyses. RESULTS: One hundred and twelve pancreatic cystic neoplasms were resected; there was one perioperative death. Mucinous cysts were common (78%), followed by serous cysts (13%). In total, 17% of cysts harbored malignancy. On multivariate analysis, the risk of malignancy in cysts≥3 cm was more than 4 times that of smaller cysts (relative risk (RR)=4.32; 95% CI, 1.55-12.07). There was no significant difference in serum CEA, cancer antigen 19-9, or cyst-fluid CEA levels between the benign and malignant groups. At a median follow-up of 30 months, the incidence of diabetes was 15%. CONCLUSIONS: Surgical resection of pancreatic cysts can be performed with low perioperative mortality and acceptable long-term morbidity. Use of cyst size as a rationale for resection of cystic lesion, as per the Sendai criteria, is justified.

7 Article Sendai and Fukuoka Consensus Guidelines Identify Advanced Neoplasia in Patients With Suspected Mucinous Cystic Neoplasms of the Pancreas. 2015

Kaimakliotis, Pavlos / Riff, Brian / Pourmand, Kamron / Chandrasekhara, Vinay / Furth, Emma E / Siegelman, Evan S / Drebin, Jeffery / Vollmer, Charles M / Kochman, Michael L / Ginsberg, Gregory G / Ahmad, Nuzhat A. ·Division of Gastroenterology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania. · Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania. · Department of Surgical Pathology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania. · Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania. · Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania. · Division of Gastroenterology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania. Electronic address: Nuzhat.ahmad@uphs.upenn.edu. ·Clin Gastroenterol Hepatol · Pubmed #25818077.

ABSTRACT: BACKGROUND & AIMS: Little is known about whether the 2006 Sendai guidelines or 2012 Fukuoka guidelines are being used to determine the level of risk posed by suspected pancreatic mucinous cystic neoplasms (PCNs). We evaluated whether the guidelines accurately predicted which patients with suspected PCNs, which was based on cross-sectional imaging findings, would be found to have advanced neoplasia in surgery. METHODS: We performed a retrospective study of data collected from 194 patients with cystic lesions of the pancreas, which were assessed by cross-sectional imaging analyses, who underwent surgery for suspected PCNs at the Hospital at the University of Pennsylvania from 2000 through 2008. Imaging data were used to classify patients according to the Sendai guidelines as high risk or low risk and according to the Fukuoka guidelines as high risk, worrisome, or low risk. Pathology analyses of samples collected during surgery were used as the reference. A logistic regression model was created to identify factors associated with advanced neoplasia. The Sendai and Fukuoka guideline criteria were analyzed by univariate and multivariable logistic regression analyses. RESULTS: Advanced neoplasias were found in 36 patients (18.5%; 22 invasive cancers and 14 high-grade dysplasias). The median size of cysts was 33 mm. All patients found to have invasive cancers were accurately assigned to the Sendai guidelines high risk or Fukuoka guidelines high risk groups. However, 3 patients in the Sendai guidelines low risk and 2 patients in the Fukuoka guidelines low risk groups were found to have high-grade dysplasia. The Sendai guidelines identified patients with advanced neoplasia with 91.7% sensitivity, 21.5% specificity, 21% positive predictive value, and 91.9% negative predictive value. A designation of Fukuoka guidelines high risk identified patients with advanced neoplasia with 55.6% sensitivity, 73% specificity, 32% positive predictive value, and 87.9% negative predictive value. Overall, there was no statistically significant difference between the guidelines in predicting which patients had advanced neoplasia. On multivariate analysis, the presence of a mural nodule (odds ratio [OR], 2.88; 95% confidence interval [CI], 1.33-6.27; P = .008), dilated main pancreatic duct >10 mm (OR, 7.44; 95% CI, 2.36-23.52; P = .001), or enhancing solid component (OR, 2.92; 95% CI, 1.16-7.64; P = .02) were associated with detection of advanced neoplasia in pancreatic cysts. CONCLUSION: On the basis of a retrospective analysis, the Sendai and Fukuoka guidelines accurately determine which patients with pancreatic cysts have advanced neoplasia. The guidelines accurately recommended surgical resection for all patients found to have invasive cancer, although some patients with high-grade dysplasia were missed. The updated Fukuoka guidelines are not superior to the Sendai guidelines in identifying neoplasias. Cyst size was not associated with advanced neoplasia.

8 Article Detection of circulating pancreas epithelial cells in patients with pancreatic cystic lesions. 2014

Rhim, Andrew D / Thege, Fredrik I / Santana, Steven M / Lannin, Timothy B / Saha, Trisha N / Tsai, Shannon / Maggs, Lara R / Kochman, Michael L / Ginsberg, Gregory G / Lieb, John G / Chandrasekhara, Vinay / Drebin, Jeffrey A / Ahmad, Nuzhat / Yang, Yu-Xiao / Kirby, Brian J / Stanger, Ben Z. ·Division of Gastroenterology, Department of Internal Medicine, Pancreatic Cancer Center, University of Michigan Comprehensive Cancer Center, University of Michigan Medical School, Ann Arbor, Michigan; Gastroenterology Division, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Abramson Cancer Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania. Electronic address: arhim@med.umich.edu. · Department of Biomedical Engineering, Cornell University, Ithaca, New York. · Sibley School of Mechanical and Aerospace Engineering, Cornell University, Ithaca, New York. · Division of Gastroenterology, Department of Internal Medicine, Pancreatic Cancer Center, University of Michigan Comprehensive Cancer Center, University of Michigan Medical School, Ann Arbor, Michigan; Gastroenterology Division, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania. · Gastroenterology Division, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Abramson Cancer Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania. · Gastroenterology Division, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Abramson Cancer Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Department of Cell and Developmental Biology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania. · Abramson Cancer Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania. · Gastroenterology Division, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania. · Sibley School of Mechanical and Aerospace Engineering, Cornell University, Ithaca, New York; Department of Medicine, Division of Hematology/Medical Oncology, Weill Cornell Medical College, New York, New York. Electronic address: kirby@cornell.edu. · Gastroenterology Division, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Abramson Cancer Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Department of Cell and Developmental Biology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania. Electronic address: stanger@exchange.upenn.edu. ·Gastroenterology · Pubmed #24333829.

ABSTRACT: Hematogenous dissemination is thought to be a late event in cancer progression. We recently showed in a genetic model of pancreatic ductal adenocarcinoma that pancreas cells can be detected in the bloodstream before tumor formation. To confirm these findings in humans, we used microfluidic geometrically enhanced differential immunocapture to detect circulating pancreas epithelial cells in patient blood samples. We captured more than 3 circulating pancreas epithelial cells/mL in 7 of 21 (33%) patients with cystic lesions and no clinical diagnosis of cancer (Sendai criteria negative), 8 of 11 (73%) with pancreatic ductal adenocarcinoma, and in 0 of 19 patients without cysts or cancer (controls). These findings indicate that cancer cells are present in the circulation of patients before tumors are detected, which might be used in risk assessment.