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Pancreatic Neoplasms: HELP
Articles by Mouen A. Khashab
Based on 27 articles published since 2008
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Between 2008 and 2019, M. Khashab wrote the following 27 articles about Pancreatic Neoplasms.
 
+ Citations + Abstracts
Pages: 1 · 2
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 Review EUS and related technologies for the diagnosis and treatment of pancreatic disease: research gaps and opportunities-Summary of a National Institute of Diabetes and Digestive and Kidney Diseases workshop. 2017

Lee, Linda S / Andersen, Dana K / Ashida, Reiko / Brugge, William R / Canto, Mimi I / Chang, Kenneth J / Chari, Suresh T / DeWitt, John / Hwang, Joo Ha / Khashab, Mouen A / Kim, Kang / Levy, Michael J / McGrath, Kevin / Park, Walter G / Singhi, Aatur / Stevens, Tyler / Thompson, Christopher C / Topazian, Mark D / Wallace, Michael B / Wani, Sachin / Waxman, Irving / Yadav, Dhiraj / Singh, Vikesh K. ·Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA. · Division of Digestive Diseases and Nutrition, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland, USA. · Departments of Cancer Survey and Gastrointestinal Oncology, Osaka Prefectural Hospital Organization, Osaka International Cancer Institute, Osaka, Japan. · Department of Gastroenterology, Massachusetts General Hospital, Boston, Massachusetts, USA. · Division of Gastroenterology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA. · Comprehensive Digestive Disease Center, Department of Gastroenterology and Hepatology, University of California at Irvine Health, Orange, California, USA. · Department of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA. · Division of Gastroenterology, Indiana University Health Medical Center, Indianapolis, Indiana, USA. · Department of Medicine, University of Washington, Seattle, Washington, USA. · Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA. · Division of Gastroenterology, Hepatology, and Nutrition, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA. · Department of Medicine, Stanford University School of Medicine, Stanford, California, USA. · Department of Pathology, University of Pittsburgh Medical Center, Sewickley, Pennsylvania, USA. · Department of Gastroenterology, Cleveland Clinic, Cleveland, Ohio, USA. · Department of Gastroenterology and Hepatology, Mayo Clinic Florida, Jacksonville, Florida, USA. · Division of Gastroenterology and Hepatology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA. · Department of Medicine, The University of Chicago Comprehensive Cancer Center, University of Chicago School of Medicine, Chicago, Illinois, USA. ·Gastrointest Endosc · Pubmed #28941651.

ABSTRACT: A workshop was sponsored by the National Institute of Diabetes and Digestive and Kidney Diseases to address the research gaps and opportunities in pancreatic EUS. The event occurred on July 26, 2017 in 4 sessions: (1) benign pancreatic diseases, (2) high-risk pancreatic diseases, (3) diagnostic and therapeutics, and (4) new technologies. The current state of knowledge was reviewed, with identification of numerous gaps in knowledge and research needs. Common themes included the need for large multicenter consortia of various pancreatic diseases to facilitate meaningful research of these entities; to standardize EUS features of different pancreatic disorders, the technique of sampling pancreatic lesions, and the performance of various therapeutic EUS procedures; and to identify high-risk disease early at the cellular level before macroscopic disease develops. The need for specialized tools and accessories to enable the safe and effective performance of therapeutic EUS procedures also was discussed.

3 Review A systematic review of solid-pseudopapillary neoplasms: are these rare lesions? 2014

Law, Joanna K / Ahmed, Aadil / Singh, Vikesh K / Akshintala, Venkata S / Olson, Matthew T / Raman, Siva P / Ali, Syed Z / Fishman, Elliot K / Kamel, Ihab / Canto, Marcia I / Dal Molin, Marco / Moran, Robert A / Khashab, Mouen A / Ahuja, Nita / Goggins, Michael / Hruban, Ralph H / Wolfgang, Christopher L / Lennon, Anne Marie. ·From the *Division of Gastroenterology, †Department of Pathology, ‡Department of Radiology, Johns Hopkins University School of Medicine, §Department of Pathology, Sol Goldman Pancreatic Cancer Research Center, and ∥Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD. ·Pancreas · Pubmed #24622060.

ABSTRACT: OBJECTIVE: The aim of the study was to determine if there had been any change in the number of solid-pseudopapillary neoplasm (SPN) cases detected and their evaluation or management over time. METHODS: A systematic review of SPN was performed of all articles published in English in PubMed and Scopus. RESULTS: A total of 2744 patients with SPN were identified in 484 studies published between 1961 and 2012; 87.8% of the cases were reported between 2000 and 2012. A total of 2408 (87.8%) were females, and the mean age was 28.5 (SD, 13.7) years. The most common symptom was abdominal pain in 63.6% of the cases and incidentally detected in 38.1% of the cases. There were 2285 patients who underwent pancreatic resection. The mean tumor size was 8.6 (SD, 4.3) cm. Follow-up was reported for 1952 (90.5%) patients, with a mean follow-up of 36.1 (SD, 32.8) months. Disease-free survival was documented in 1866 (95.6%) patients with recurrence in 86 (4.4%) patients; the median time to recurrence was 50.5 months. CONCLUSIONS: The number of SPNs reported in the literature has seen a 7-fold increase in the number of cases reported since 2000 compared with before. Solid-pseudopapillary neoplasms continue to be primarily found in young women and present with nonspecific symptoms. Surgery remains the mainstay of treatment with an excellent long-term prognosis.

4 Clinical Trial Stylet slow-pull versus standard suction for endoscopic ultrasound-guided fine-needle aspiration of solid pancreatic lesions: a multicenter randomized trial. 2018

Saxena, Payal / El Zein, Mohamad / Stevens, Tyler / Abdelgelil, Ahmed / Besharati, Sepideh / Messallam, Ahmed / Kumbhari, Vivek / Azola, Alba / Brainard, Jennifer / Shin, Eun Ji / Lennon, Anne Marie / Canto, Marcia I / Singh, Vikesh K / Khashab, Mouen A. ·Division of Gastroenterology, Department of Medicine, Johns Hopkins Hospital, Baltimore, Maryland, United States. · Division of Gastroenterology, Department of Medicine, Royal Prince Alfred Hospital, Sydney, Australia. · Digestive Disease Institute, Department of Gastroenterology and Hepatology, Cleveland Clinic, Cleveland, Ohio, United States. · Pathology and Laboratory Medicine Institute, Department of Anatomic Pathology, Cleveland Clinic, Cleveland, Ohio, United States. ·Endoscopy · Pubmed #29272906.

ABSTRACT: BACKGROUND AND STUDY AIM: Standard endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) procedures involve use of no-suction or suction aspiration techniques. A new aspiration method, the stylet slow-pull technique, involves slow withdrawal of the needle stylet to create minimum negative pressure. The aim of this study was to compare the sensitivity of EUS-FNA using stylet slow-pull or suction techniques for malignant solid pancreatic lesions using a standard 22-gauge needle. PATIENTS AND METHODS: Consecutive patients presenting for EUS-FNA of pancreatic mass lesions were randomized to the stylet slow-pull or suction techniques using a 22-gauge needle. Both techniques were standardized for each pass until an adequate specimen was obtained, as determined by rapid on-site cytology examination. Patients were crossed over to the alternative technique after four nondiagnostic passes. RESULTS: Of 147 patients screened, 121 (mean age 64 ± 13.8 years) met inclusion criteria and were randomized to the stylet slow-pull technique (n = 61) or the suction technique (n = 60). Technical success rates were 96.7 % and 98.3 % in the slow-pull and suction groups, respectively ( CONCLUSIONS: The stylet slow-pull and suction techniques both offered high and comparable diagnostic sensitivity with a mean of 2 passes required for diagnosis of solid pancreatic lesions. The endosonographer may choose either technique during FNA.

5 Article Pancreatic Carcinoma Diagnosed by Peroral Pancreatoscopy Using the SpyGlass System. 2017

Barola, Sindhu / Tadimeti, Hima / Chen, Yen-I / Ngamruengphong, Saowanee / Khashab, Mouen A / Kalloo, Anthony N / Kumbhari, Vivek. ·Division of Gastroenterology and Hepatology, Department of Medicine, The Johns Hopkins Medical Institutions, Baltimore, Maryland, USA. · Department of Radiology and Radiological Science, The Johns Hopkins Medical Institutions, Baltimore, Maryland, USA. ·Am J Gastroenterol · Pubmed #28572652.

ABSTRACT: -- No abstract --

6 Article Metastatic pancreatic adenocarcinoma associated with chronic calcific pancreatitis and a heterozygous SPINK1 N34S mutation. 2016

Moran, Robert A / Klapheke, Robert / Jalaly, Niloofar Y / Makary, Martin A / Hirose, Kenzo / Goggins, Michael / Wood, Laura / Laheru, Daniel A / Lennon, Anne Marie / Khashab, Mouen A / Singh, Vikesh K. ·Pancreatitis Center, Division of Gastroenterology, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Division of Gastroenterology, Johns Hopkins University School of Medicine, Baltimore, MD, USA. Electronic address: rmoran13@jhmi.edu. · Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA. · Division of Gastroenterology, Johns Hopkins University School of Medicine, Baltimore, MD, USA. · Division of Surgical Oncology, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA. · Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, MD, USA. · Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, USA. · Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, MD, USA. · Pancreatitis Center, Division of Gastroenterology, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Division of Gastroenterology, Johns Hopkins University School of Medicine, Baltimore, MD, USA. ·Pancreatology · Pubmed #27358244.

ABSTRACT: Contrary to patients with a cationic trypsinogen gene (PRSS1) mutations, Serine protease inhibitor Kazal-type 1 (SPINK1) heterozygote gene mutation carriers have a very low penetrance for acute, acute recurrent and/or chronic pancreatitis. Despite this, heterozygote SPINK 1 gene mutation patients have a similar age of onset of pancreatitis as PRSS 1 gene mutation patients. While the substantially elevated risk of pancreatic cancer in patients with PRSS1 gene mutations with chronic pancreatitis has been well established, little is known about the risk of pancreatic cancer in SPINK 1 gene mutation carriers with pancreatitis. We describe a case of malignant pancreatic cancer diagnosed in a young patient with chronic pancreatitis who is a SPINK 1 heterozygote gene mutation carrier. The risk of pancreatic cancer in gene mutation patients with chronic pancreatitis, in addition to screening options and management options for these patients is discussed.

7 Article A novel "balloon/snare apparatus" technique to facilitate easy creation of fistula tract during EUS-guided gastroenterostomy. 2016

Ngamruengphong, Saowanee / Kumbhari, Vivek / Tieu, Alan H / Haito-Chavez, Yamile / Bukhari, Majidah / Hajiyeva, Gulara / Ismail, Amr / Aguila, Gerard / Chen, Yen-I / Khashab, Mouen A. ·Department of Medicine and Division of Gastroenterology and Hepatology, The Johns Hopkins Medical Institutions, Baltimore, Maryland, USA. ·Gastrointest Endosc · Pubmed #27048972.

ABSTRACT: -- No abstract --

8 Article Double endoscopic bypass by using lumen-apposing stents (with videos). 2016

Khashab, Mouen A / El Zein, Mohamad / Ngamruengphong, Saowanee / Haito Chavez, Yamile / Kumbhari, Vivek / Ismail, Amr / Tieu, Alan H / Aguila, Gerad / Singh, Vikesh K / Lennon, Anne Marie / Canto, Marcia Irene / Kalloo, Anthony N. ·Division of Gastroenterology and Hepatology, Department of Medicine, The Johns Hopkins Medical Institutions, Baltimore, Maryland, USA. ·Gastrointest Endosc · Pubmed #26773639.

ABSTRACT: -- No abstract --

9 Article Reliable Detection of Somatic Mutations in Fine Needle Aspirates of Pancreatic Cancer With Next-generation Sequencing: Implications for Surgical Management. 2016

Valero, Vicente / Saunders, Tyler J / He, Jin / Weiss, Matthew J / Cameron, John L / Dholakia, Avani / Wild, Aaron T / Shin, Eun Ji / Khashab, Mouen A / O'Broin-Lennon, Anne Marie / Ali, Syed Z / Laheru, Daniel / Hruban, Ralph H / Iacobuzio-Donahue, Christine A / Herman, Joseph M / Wolfgang, Christopher L. ·*Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD †Department of Pathology ‡Department of Oncology, The Johns Hopkins University School of Medicine, Baltimore, MD §Department of Radiation Oncology and Molecular Radiation Sciences, The Johns Hopkins University School of Medicine, Baltimore, MD ¶Department of Gastroenterology and Hepatology, The Sol Goldman Pancreatic Cancer Research Center, The Johns Hopkins University School of Medicine, Baltimore, MD. ·Ann Surg · Pubmed #26020105.

ABSTRACT: OBJECTIVE: To determine the feasibility of genotyping pancreatic tumors via fine needle aspirates (FNAs). BACKGROUND: FNA is a common method of diagnosis for pancreatic cancer, yet it has traditionally been considered inadequate for molecular studies due to the limited quantity of DNA derived from FNA specimens and tumor heterogeneity. METHODS: In vitro mixing studies were performed to deduce the minimum cellularity needed for genetic analysis. DNA from both simulated FNAs and clinical FNAs was sequenced. Mutational concordance was determined between simulated FNAs and that of the resected specimen. RESULTS: Limiting dilution studies indicated that mutations present at allele frequencies as low as 0.12% are detectable. Comparison of simulated FNAs and matched tumor tissue exhibited a concordance frequency of 100% for all driver genes present. In FNAs obtained from 17 patients with unresectable disease, we identified at least 1 driver gene mutation in all patients including actionable somatic mutations in ATM and MTOR. The constellation of mutations identified in these patients was different than that reported for resectable pancreatic cancers, implying a biologic basis for presentation with locally advanced pancreatic cancer. CONCLUSIONS: FNA sequencing is feasible and subsets of patients may harbor actionable mutations that could potentially impact therapy. Moreover, preoperative FNA sequencing has the potential to influence the timing of surgery relative to systemic therapy. FNA sequencing opens the door to clinical trials in which patients undergo neoadjuvant or a surgery-first approach based on their tumor genetics with the goal of utilizing cancer genomics in the clinical management of pancreatic cancer.

10 Article EUS-guided biliary drainage with antegrade transpapillary placement of a metal biliary stent. 2015

Saxena, Payal / Kumbhari, Vivek / El Zein, Mohamad / Kalloo, Anthony N / Khashab, Mouen A. ·Department of Medicine and Division of Gastroenterology and Hepatology, The Johns Hopkins Medical Institutions, Baltimore, Maryland, USA. ·Gastrointest Endosc · Pubmed #25262101.

ABSTRACT: -- No abstract --

11 Article Liver transplant patients have a risk of progression similar to that of sporadic patients with branch duct intraductal papillary mucinous neoplasms. 2014

Lennon, Anne Marie / Victor, David / Zaheer, Atif / Ostovaneh, Mohammad Reza / Jeh, Jessica / Law, Joanna K / Rezaee, Neda / Molin, Marco Dal / Ahn, Young Joon / Wu, Wenchuan / Khashab, Mouen A / Girotra, Mohit / Ahuja, Nita / Makary, Martin A / Weiss, Matthew J / Hirose, Kenzo / Goggins, Michael / Hruban, Ralph H / Cameron, Andrew / Wolfgang, Christopher L / Singh, Vikesh K / Gurakar, Ahmet. ·Division of Gastroenterology and Hepatology, The Sol Goldman Pancreatic Cancer Research Center, The Johns Hopkins Medical Institutions, Baltimore, MD; Division of Surgery, The Sol Goldman Pancreatic Cancer Research Center, The Johns Hopkins Medical Institutions, Baltimore, MD. ·Liver Transpl · Pubmed #25155689.

ABSTRACT: Intraductal papillary mucinous neoplasms (IPMNs) have malignant potential and can progress from low- to high-grade dysplasia to invasive adenocarcinoma. The management of patients with IPMNs is dependent on their risk of malignant progression, with surgical resection recommended for patients with branch-duct IPMN (BD-IPMN) who develop high-risk features. There is increasing evidence that liver transplant (LT) patients are at increased risk of extrahepatic malignancy. However, there are few data regarding the risk of progression of BD-IPMNs in LT recipients. The aim of this study was to determine whether LT recipients with BD-IPMNs are at higher risk of developing high-risk features than patients with BD-IPMNs who did not receive a transplant. Consecutive patients who underwent an LT with BD-IPMNs were included. Patients with BD-IPMNs with no history of immunosuppression were used as controls. Progression of the BD-IPMNs was defined as development of a high-risk feature (jaundice, dilated main pancreatic duct, mural nodule, cytology suspicious or diagnostic for malignancy, cyst diameter ≥3 cm). Twenty-three LT patients with BD-IPMN were compared with 274 control patients. The median length of follow-up was 53.7 and 24.0 months in LT and control groups, respectively. Four (17.4%) LT patients and 45 (16.4%) controls developed high-risk features (P = 0.99). In multivariate analysis, progression of BD-IPMNs was associated with age at diagnosis but not with LT. There was no statistically significant difference in the risk of developing high-risk features between the LT and the control groups.

12 Article Endoscopic ultrasound-guided fine needle aspiration improves the pre-operative diagnostic yield of solid-pseudopapillary neoplasm of the pancreas: an international multicenter case series (with video). 2014

Law, Joanna K / Stoita, Alina / Wever, Wallia / Gleeson, Ferga C / Dries, Andrew M / Blackford, Amanda / Kiswani, Vandhana / Shin, Eun Ji / Khashab, Mouen A / Canto, Marcia Irene / Singh, Vikesh K / Lennon, Anne Marie. ·Division of Gastroenterology and Hepatology, The Sol Goldman Pancreatic Cancer Research Center, The Johns Hopkins Medical Institutions, 1800 Orleans St, Suite 7125 J, Baltimore, MD, 21205, USA, jlaw8@jhmi.edu. ·Surg Endosc · Pubmed #24718662.

ABSTRACT: BACKGROUND/OBJECTIVES: Solid-pseudopapillary neoplasms (SPNs) are rare pancreatic tumors, which occur most frequently in young women and are associated with an excellent prognosis. Computed tomography (CT) is used most commonly to identify these lesions, but there are few studies evaluating the role of endoscopic ultrasound (EUS) and fine needle aspiration (EUS-FNA) in the assessment of SPN. The aim of the study was to determine the incremental diagnostic yield of EUS-FNA compared with CT or EUS in the evaluation of patients with SPN. METHODS: A retrospective chart review of consecutive patients diagnosed with SPN who underwent CT, EUS, and EUS-FNA at five centers from three countries from 1998 to 2013. Patient demographics, imaging, endoscopic studies, cytopathology, and histology were reviewed. RESULTS: Thirty-four patients were identified with SPN. There were 31 (91.2 %) females, with a mean age at diagnosis of 37 years (range 16-81). The most common presenting symptom was abdominal pain which was present in 59 %. SPNs were incidentally detected in 14 (41.2 %) of the patients. The median tumor size was 4.2 cm (range 1.9-9.4). No patient had evidence of local or distant metastases. The most common appearance on EUS was of a mixed solid-cystic lesion (67.6 %). The diagnostic yield of CT and EUS alone was 23.5 and 41.2 %, respectively. CT and EUS combined had a diagnostic yield of 52.9 %. The addition of EUS-FNA significantly increased the diagnostic yield to 82.4 % compared with either CT or CT and EUS (p < 0.005). There were no reported adverse events reported. CONCLUSIONS: SPNs are rare pancreatic tumors primarily affecting young women. The addition of EUS-FNA significantly increased the pre-operative diagnostic yield of SPN to 82.4 %.

13 Article The role of endoscopy in the treatment, management, and personalization of pancreatic cancer. 2013

Shin, Eun Ji / Khashab, Mouen. · ·Curr Probl Cancer · Pubmed #24331185.

ABSTRACT: -- No abstract --

14 Article Pancreatic metastasis from a solitary fibrous tumor of the kidney: a rare cause of acute recurrent pancreatitis. 2013

Patel, Yuval A / Dhalla, Sameer / Olson, Matthew T / Lennon, Anne Marie / Khashab, Mouen A / Singh, Vikesh K. ·Department of Medicine, Johns Hopkins Medical Institutions, Baltimore, MD, USA. Electronic address: ypatel2@jhmi.edu. ·Pancreatology · Pubmed #24280583.

ABSTRACT: Solitary fibrous tumors are unusual spindle cell neoplasms that uncommonly originate from the kidney. We report a case of a 43-year old male who presented with acute recurrent pancreatitis secondary to a mass in the head of the pancreas. Endoscopic ultrasound with fine needle aspiration (EUS-FNA) was performed. Cytology revealed solitary fibrous tumor of the kidney. This is the first reported case of solitary fibrous tumor metastasizing to the pancreas and presenting as acute recurrent pancreatitis.

15 Article EUS-guided biliary drainage by using a hepatogastrostomy approach. 2013

Khashab, Mouen A / Kumbhari, Vivek / Kalloo, Anthony N / Saxena, Payal. ·Department of Medicine and Division of Gastroenterology and Hepatology, The Johns Hopkins Medical Institutions, Baltimore, Maryland, USA. ·Gastrointest Endosc · Pubmed #23953233.

ABSTRACT: -- No abstract --

16 Article EUS-guided biliary drainage by using a standardized approach for malignant biliary obstruction: rendezvous versus direct transluminal techniques (with videos). 2013

Khashab, Mouen A / Valeshabad, Ali Kord / Modayil, Rani / Widmer, Jessica / Saxena, Payal / Idrees, Mehak / Iqbal, Shahzad / Kalloo, Anthony N / Stavropoulos, Stavros N. ·Department of Medicine and Division of Gastroenterology and Hepatology, The Johns Hopkins Medical Institutions, Baltimore, Maryland, USA. ·Gastrointest Endosc · Pubmed #23886353.

ABSTRACT: BACKGROUND: EUS-guided biliary drainage (EGBD) can be performed via direct transluminal or rendezvous techniques. It is unknown how both techniques compare in terms of efficacy and adverse events. OBJECTIVE: To describe outcomes of EGBD performed by using a standardized approach and compare outcomes of rendezvous and transluminal techniques. DESIGN: Retrospective analysis of prospectively collected data. SETTING: Two tertiary-care centers. PATIENTS: Consecutive jaundiced patients with distal malignant biliary obstruction who underwent EGBD after failed ERCP between July 2006 and December 2012 were included. INTERVENTION: EGBD by using a standardized algorithm. MAIN OUTCOME MEASUREMENTS: Technical success, clinical success, and adverse events. RESULTS: During the study period, 35 patients underwent EGBD (rendezvous n = 13, transluminal n = 20). Technical success was achieved in 33 patients (94%), and clinical success was attained in 32 of 33 patients (97.0%). The mean postprocedure bilirubin level was 1.38 mg/dL in the rendezvous group and 1.33 mg/dL in the transluminal group (P = .88). Similarly, length of hospital stay was not different between groups (P = .23). There was no significant difference in adverse event rate between rendezvous and transluminal groups (15.4% vs 10%; P = .64). Long-term outcomes were comparable between groups, with 1 stent migration in the rendezvous group at 62 days and 1 stent occlusion in the transluminal group at 42 days after EGBD. LIMITATIONS: Retrospective analysis, small number of patients, and selection bias. CONCLUSION: EGBD is safe and effective when the described standardized approach is used. Stent occlusion is not common during long-term follow-up. Both rendezvous and direct transluminal techniques seem to be equally effective and safe. The latter approach is a reasonable alternative to rendezvous EGBD.

17 Article Endoscopic ultrasound (EUS)-guided fiducial placement allows localization of small neuroendocrine tumors during parenchymal-sparing pancreatic surgery. 2013

Law, Joanna K / Singh, Vikesh K / Khashab, Mouen A / Hruban, Ralph H / Canto, Marcia Irene / Shin, Eun Ji / Saxena, Payal / Weiss, Matthew J / Pawlik, Timothy M / Wolfgang, Christopher L / Lennon, Anne Marie. ·Division of Gastroenterology, Johns Hopkins Hospital, Baltimore, MD, USA, jlaw8@jhmi.edu. ·Surg Endosc · Pubmed #23636530.

ABSTRACT: BACKGROUND: Parenchymal-sparing pancreatic surgery is ideal for lesions such as small pancreatic neuroendocrine tumors (PanNET). However, precise localization of these small tumors at surgery can be difficult. The placement of fiducials under endoscopic ultrasound (EUS) guidance (EUS-F) has been used to direct stereotactic radiation therapy for pancreatic adenocarcinoma. This report describes two cases in which placement of fiducials was used to guide surgical resection. This study aimed to assess the feasibility, safety, and efficacy of using EUS-F for intraoperative localization of small PanNETs. METHODS: A retrospective study analyzed two consecutive patients with small PanNETs who underwent EUS-F followed by enucleation in a tertiary-care referral hospital. The following features were examined: technical success and complication rates of EUS-F, visibility of the fiducial at the time of surgery, and fiducial migration. RESULTS: In the study, EUS-F was performed for two female patients with a 7-mm and a 9-mm PanNET respectively in the uncinate process and neck of the pancreas. In both patients, EUS-F was feasible with two Visicoil fiducials (Core Oncology, Santa Barbara, CA, USA) placed either within or adjacent to the tumors using a 22-gauge Cook Echotip needle. At surgery, the fiducials were clearly visible on intraoperative ultrasound, and both the tumor and the fiducials were successfully enucleated in both cases. No complications were associated with EUS-F, and no evidence of pancreatitis was shown either clinically or on surgical pathology. This investigation had the limitations of a small single-center study. CONCLUSIONS: For patients undergoing enucleation, EUS-F is technically feasible and safe and aids intraoperative localization of small PanNETs.

18 Article Should we do EUS/FNA on patients with pancreatic cysts? The incremental diagnostic yield of EUS over CT/MRI for prediction of cystic neoplasms. 2013

Khashab, Mouen A / Kim, Katherine / Lennon, Anne Marie / Shin, Eun Ji / Tignor, April S / Amateau, Stuart K / Singh, Vikesh K / Wolfgang, Christopher L / Hruban, Ralph H / Canto, Marcia Irene. ·Department of Medicine and Division of Gastroenterology and Hepatology, The Sol Goldman Pancreatic Cancer Research Center, The Johns Hopkins Medical Institutions, Baltimore, MD, USA. ·Pancreas · Pubmed #23558241.

ABSTRACT: OBJECTIVES: To evaluate the performance characteristics of endoscopic ultrasonography (EUS) compared with computed tomography (CT) and magnetic resonance imaging (MRI) and determine the incremental diagnostic yield and accuracy of EUS with or without fine needle aspiration (FNA) over CT and MRI for prediction of neoplastic pancreatic cysts. METHODS: The EUS database was queried for procedures performed for pancreatic cysts between March 2006 and January 2010. Cystic pancreatic ductal adenocarcinoma, cystic pancreatic neuroendocrine tumor, mucinous cystic neoplasm, intraductal papillary neoplasm, and solid pseudopapillary neoplasm were categorized as neoplastic; pseudocysts and serous cysts were designated as nonneoplastic/low risk. RESULTS: Final diagnoses were established by surgery in 154 patients (mucinous cystic neoplasm/intraductal papillary neoplasm [69.4%], pancreatic neuroendocrine tumor [10%], pancreatic ductal adenocarcinoma [6.4%], solid pseudopapillary neoplasm [0.6%], nonneoplastic/low risk [13.6%]). Endoscopic ultrasonography with or without FNA was superior to CT and MRI in accurately classifying a cyst as neoplastic (P < 0.0001). After CT and MRI, EUS increased the rate of correctly predicting neoplastic cysts in 43 (36%) and 27 (54%) additional cases, respectively. CONCLUSIONS: The incremental increase in diagnostic yield of EUS and fluid analysis over CT and MRI for prediction of a neoplastic cyst is 36% and 54%, respectively. The addition of EUS-FNA to abdominal imaging significantly increases overall accuracy for diagnosis of neoplastic pancreatic cysts.

19 Article Comparative analysis of traditional and coiled fiducials implanted during EUS for pancreatic cancer patients receiving stereotactic body radiation therapy. 2012

Khashab, Mouen A / Kim, Katherine J / Tryggestad, Erik J / Wild, Aaron T / Roland, Teboh / Singh, Vikesh K / Lennon, Anne Marie / Shin, Eun Ji / Ziegler, Mark A / Sharaiha, Reem Z / Canto, Marcia Irene / Herman, Joseph M. ·Department of Gastroenterology and Hepatology, Johns Hopkins Hospital, Baltimore, Maryland 21205, USA. ·Gastrointest Endosc · Pubmed #23078921.

ABSTRACT: BACKGROUND: EUS-guided fiducial placement facilitates image-guided radiation therapy (IGRT). OBJECTIVE: To compare 2 types of commercially available fiducials for technical success, complications, visibility, and migration. DESIGN: Retrospective, single-center, comparative study. SETTING: Tertiary-care medical center. INTERVENTIONS: Traditional fiducials (TFs) (5-mm length, 0.8-mm diameter) and Visicoil fiducials (VFs) (10-mm length, 0.35-mm diameter) were compared. Fiducials were placed using linear 19-gauge (for TFs) or 22-gauge (for VFs) needles. A subjective visualization scoring system (0-2; 0 = not visible, 1 = barely visible, 2 = clearly visible) was used to assess visibility on CT. Fiducial migration was calculated as a change in interfiducial distance. MAIN OUTCOME MEASUREMENTS: Technical success, complications, visibility, and migration of 2 types of fiducials. RESULTS: Thirty-nine patients with locally advanced pancreatic cancer underwent EUS-guided placement of 103 fiducials (77 TFs, 26 VFs). The mean number of fiducials placed per patient was 2.66 (standard deviation 0.67) for the 19-gauge needle and 2.60 (standard deviation 0.70) for the 22-gauge needle (P = .83). No intra- or postprocedural complications were encountered. The median visibility score for TFs was significantly better than that for VFs, both when scores of 0 were and were not included (2.00, interquartile range [IQR] 2.00-2.00 vs 1.75, IQR 1.50-2.00, P = .009 and 2.00, IQR 2.00-2.00 vs 2.00, IQR 1.50-2.00, P < .0001, respectively). The mean migration was not significantly different between the 2 types of fiducials (0.8 mm [IQR 0.4-1.6 mm] for TFs vs 1.3 mm [IQR 0.6-1.5 mm] for VFs; P = .72). LIMITATIONS: Retrospective, nonrandomized design. CONCLUSIONS: Visibility was significantly better for TFs compared with VFs. The degree of fiducial migration was not significantly different for TFs and VFs. There was no significant difference in the mean number of fiducials placed, indicating a similar degree of technical difficulty for TF and VF deployment.

20 Article EUS-guided biliary drainage for patients with malignant biliary obstruction with an indwelling duodenal stent (with videos). 2012

Khashab, Mouen A / Fujii, Larissa L / Baron, Todd H / Canto, Marcia Irene / Gostout, Christopher J / Petersen, Bret T / Okolo, Patrick I / Topazian, Mark D / Levy, Michael J. ·Division of Gastroenterology and Hepatology, Department of Medicine, The Johns Hopkins Medical Institutions, Baltimore, Maryland 21205, USA. ·Gastrointest Endosc · Pubmed #22726485.

ABSTRACT: -- No abstract --

21 Article Pancreaticobiliary obstruction following duodenal stent placement. 2012

Amateau, S K / Wolfgang, C L / Khashab, M A. ·Department of Internal Medicine, Division of Gastroenterology and Hepatology, The Johns Hopkins Hospital, Baltimore, Maryland 21205, USA. ·Endoscopy · Pubmed #22396255.

ABSTRACT: -- No abstract --

22 Article Tumor size and location correlate with behavior of pancreatic serous cystic neoplasms. 2011

Khashab, Mouen A / Shin, Eun Ji / Amateau, Stuart / Canto, Marcia Irene / Hruban, Ralph H / Fishman, Elliot K / Cameron, John L / Edil, Barish H / Wolfgang, Christopher L / Schulick, Richard D / Giday, Samuel. ·Department of Medicine and Division of Gastroenterology and Hepatology, The Sol Goldman Pancreatic Cancer Research Center, Johns Hopkins Medical Institutions, Baltimore, Maryland 21205, USA. ·Am J Gastroenterol · Pubmed #21468008.

ABSTRACT: OBJECTIVES: The majority of pancreatic serous cystic neoplasms (SCNs) are benign. However, these neoplasms can cause symptoms and rarely can be aggressive. Identification of factors associated with symptomatic or aggressive SCNs may aid management decisions. The aim of this study was to identify variables that predict aggressive SCNs. METHODS: Prospective pathology database was queried for SCNs that were surgically resected at Johns Hopkins Hospital. Tumors were considered aggressive if they invaded surrounding structures and/or vessels or if they metastasized to lymph nodes or distant organs. The associations of gender, tumor size, and tumor location, with the presence or absence of symptoms and tumor behavior were examined using Fisher's exact test, logistic regression, and multivariate analyses. RESULTS: A total of 257 patients with SCNs underwent surgical resection. Mean tumor diameter was 4.9 cm. Tumor location in the head of pancreas (HOP) was associated with symptoms (odds ratio (OR) 1.87, 95% confidence interval (CI) 1.1-3.3). Computed tomography (CT) predicted the diagnosis of SCN in approximately a quarter of patients. Thirteen tumors (mean 10.5 cm) were considered aggressive. Multivariate analysis showed that tumor diameter (OR 1.53, 95% CI 1.24-1.89) and location of tumor in pancreatic head (OR 10.44, 95% CI 1.73-63.04) were independently associated with aggressive behavior. CONCLUSIONS: We describe the largest case series of patients with pathologically proven SCNs. CT performed poorly in preoperative diagnosis of SCNs. Large tumor size and head location predicted aggressive behavior. These factors should be considered in the management of patients with SCN.

23 Article EUS is still superior to multidetector computerized tomography for detection of pancreatic neuroendocrine tumors. 2011

Khashab, Mouen A / Yong, Elaine / Lennon, Anne Marie / Shin, Eun Ji / Amateau, Stuart / Hruban, Ralph H / Olino, Kelly / Giday, Samuel / Fishman, Elliot K / Wolfgang, Christopher L / Edil, Barish H / Makary, Martin / Canto, Marcia Irene. ·Sol Goldman Pancreatic Cancer Research Center, Johns Hopkins University, 1830 East Monument Street, Baltimore, MD 21205, USA. ·Gastrointest Endosc · Pubmed #21067742.

ABSTRACT: BACKGROUND: The role of EUS for detection of pancreatic neuroendocrine tumors (PNETs) is not clearly defined in institutions that use multidetector CT for pancreatic imaging. OBJECTIVE: The aims of this study were to (1) compare the detection rates of EUS and CT by type and size of PNET and calculate the incremental benefit of EUS over CT, (2) evaluate the CT detection rate for PNETs adjusted for improved CT technology over time, and (3) determine the factors associated with CT-negative PNETs. DESIGN: Retrospective single-center cohort study. SETTING: Johns Hopkins Hospital. PATIENTS: Patients with pathologically proven PNETs with preoperative CT. Incidentally found PNETs (resection specimens) and those without Johns Hopkins Hospital CT imaging were excluded. MAIN OUTCOME MEASUREMENT: Detection rates of CT and EUS were compared by using pathology as the reference standard. RESULTS: In 217 patients (with 231 PNETs) studied, CT detected 84% of tumors (54.3% of insulinomas). The sensitivity of CT for the detection of PNETs significantly increased with improvement in CT technology (P = .02; χ(2) for trend). CT was more likely to miss lesions <2 cm (P = .005) and insulinomas (P < .0001). In 56 patients who had both CT and EUS, the sensitivity of EUS was greater than CT (91.7% vs 63.3%; P = .0002), particularly for insulinomas (84.2% vs 31.6%; P = .001). EUS detected 20 of 22 CT-negative tumors (91%). LIMITATIONS: Retrospective nonrandomized design and referral bias. CONCLUSIONS: The detection rate of CT has significantly improved over time. CT-negative tumors are small and more likely to be insulinomas. A sequential approach of CT followed by EUS can detect most PNETs. EUS is a more sensitive initial test for the detection of suspected insulinomas.

24 Article EUS-guided tattooing before laparoscopic distal pancreatic resection (with video). 2010

Lennon, Anne Marie / Newman, Naeem / Makary, Martin A / Edil, Barish H / Shin, Eun Ji / Khashab, Mouen A / Hruban, Ralph H / Wolfgang, Christopher L / Schulick, Richard D / Giday, Samuel / Canto, Marcia I. ·Division of Gastroenterology, Department of Medicine, Johns Hopkins Medical Institutions, Baltimore, Maryland 21205, USA. ·Gastrointest Endosc · Pubmed #21034909.

ABSTRACT: BACKGROUND: Precise localization of small pancreatic tumors during laparoscopic distal pancreatectomy (LDP) can be difficult because of decreased tactile ability of laparoscopy and the homogeneous appearance of the pancreas and surrounding retroperitoneal fat. Precise localization of the lesion is critical to achieving adequate margins of resection and preserving healthy pancreatic tissue. EUS-guided fine-needle tattooing (EUS-FNT) of a pancreatic lesion before LDP has been described in single case reports, but no large series have reported its effectiveness in patients undergoing LDP. OBJECTIVE: To assess the feasibility, safety, and efficacy of EUS-FNT in consecutive patients undergoing LDP. DESIGN: Retrospective cohort study. SETTING: Tertiary-care referral hospital. PATIENTS: This study involved 30 consecutive patients who underwent LDP from 2008 to 2010. Thirteen had EUS-FNT followed by LDP, and 17 had LDP alone. INTERVENTIONS: LDP or EUS-FNT with a sterile carbon-particle tattoo followed by LDP. MAIN OUTCOME MEASUREMENTS: The following features were examined: the technical success and complication rates of EUS-FNT, visibility of the tattoo at the time of laparoscopy, durability of the tattoo, and pathologic absence of tumor at the resection margin. RESULTS: The final pathology of pancreatic lesions of patients who had EUS-FNT was similar to those who had LDP alone. The median resected tumor size was significantly larger for the LDP-alone patients (median 4.0 cm vs 1.3 cm; P = .03). Thirty-one percent (4/13) of lesions in the EUS-FNT group were not visualized by prior preoperative pancreatic protocol CT. EUS-FNT was feasible in all 13 patients at laparoscopy, with R0 resection and negative final pathology margins in all cases. The tattoo was visible in all 13 EUS-FNT cases, with mean time from EUS-FNT to surgery of 20.3 days (range, 3-69 days). There were no significant complications associated with EUS-FNT. LIMITATIONS: Small, retrospective, single-center study. CONCLUSIONS: Preoperative EUS-FNT of lesions was technically feasible and safe, and it assisted in the localization of lesions in patients before LDP. The carbon particle tattoo was durable and visible in all cases.

25 Article Endoscopic ultrasound-guided fine-needle aspiration with or without flow cytometry for the diagnosis of primary pancreatic lymphoma - a case series. 2010

Khashab, M / Mokadem, M / DeWitt, J / Emerson, R / Sherman, S / LeBlanc, J / McHenry, L / Al-Rashdan, A / Al-Haddad, M. ·Department of Medicine, and Clarian/IU Digestive Diseases Center, Indiana University School of Medicine, Indianapolis, Indiana 46202, USA. ·Endoscopy · Pubmed #20101569.

ABSTRACT: The role of endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) with flow cytometry for the diagnosis of primary pancreatic lymphoma (PPL) has not been previously described. Our aims were to describe the EUS features of PPL and the role of EUS-FNA with and without flow cytometry in the diagnosis of 16 patients. When EUS-FNA with flow cytometry was compared with EUS-FNA without flow cytometry, the sensitivities for diagnosing non-Hodgkin's lymphoma were 84.6 % versus 30.8 %, respectively ( P = 0.01). EUS-FNA with flow cytometry is a valuable tool to diagnose PPL. Flow cytometry analysis complements traditional assessment by standard cytology.

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