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Pancreatic Neoplasms: HELP
Articles by Payal Saxena
Based on 7 articles published since 2008
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Between 2008 and 2019, Payal Saxena wrote the following 7 articles about Pancreatic Neoplasms.
 
+ Citations + Abstracts
1 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.

2 Article Prevalence and outcomes of pancreatic cystic neoplasms in liver transplant recipients. 2017

Liu, Ken / Joshi, Vikram / van Camp, Louise / Yang, Qi-Wei / Baars, Judith E / Strasser, Simone I / McCaughan, Geoffrey W / Majumdar, Avik / Saxena, Payal / Kaffes, Arthur J. ·Arthur Kaffes, Sydney Medical School, The University of Sydney, NSW 2006, Australia. · AW Morrow Gastroenterology and Liver Centre, Royal Prince Alfred Hospital, Camperdown, NSW 2050, Australia. · Department of Radiology, Royal Prince Alfred Hospital, Camperdown, NSW 2050, Australia. · AW Morrow Gastroenterology and Liver Centre, Royal Prince Alfred Hospital, Camperdown, NSW 2050, Australia arthur.kaffes@sydney.edu.au. ·World J Gastroenterol · Pubmed #29358860.

ABSTRACT: AIM: To determine the prevalence, characteristics and clinical course of pancreatic cystic neoplasms (PCNs) in liver transplantation (LT) recipients. METHODS: We retrospectively studied consecutive patients who underwent LT between January 1998 to April 2016. Clinical and laboratory data were obtained from patient medical records. Imaging findings on computed tomography and magnetic resonance cholangiopancreatography were reviewed by two radiologists. RESULTS: During the study period, 872 patients underwent cadaveric LT. Pancreatic cysts were identified in 53/872 (6.1%) and 31/53 (58.5%) were PCNs [28 intraductal papillary mucinous neoplasm (IPMN), 2 mucinous cystic neoplasm (MCN), 1 serous cystadenoma]. Patients with PCNs exhibited less male predominance (55% CONCLUSION: The prevalence of PCNs in LT recipients was similar to the general population (3.6%, 31/872). Side-branch IPMNs do not appear to have accelerated malignant potential in post-LT patients, indicating the current surveillance guidelines are applicable to this group.

3 Article Refining the care of patients with pancreatic cancer: the AGITG Pancreatic Cancer Workshop consensus. 2016

Gandy, Robert C / Barbour, Andrew P / Samra, Jaswinder / Nikfarjam, Mehrdad / Haghighi, Koroush / Kench, James G / Saxena, Payal / Goldstein, David. ·Prince of Wales Hospital, Sydney, NSW d.goldstein@unsw.edu.au. · University of Queensland, Brisbane, QLD. · Royal North Shore Hospital, Sydney, NSW. · Austin Health, Melbourne, VIC. · Prince of Wales Hospital, Sydney, NSW. · Royal Prince Alfred Hospital, Sydney, NSW. ·Med J Aust · Pubmed #27318402.

ABSTRACT: A meeting of the Australasian Gastro-Intestinal Trials Group (AGITG) was held to develop a consensus statement defining when a patient with pancreatic cancer has disease that is clearly operable, is borderline, or is locally advanced/inoperable. Key issues included the need for multidisciplinary team consensus for all patients considered for surgical resection. Staging investigations, to be completed within 4 weeks of presentation, should include pancreatic protocol computed tomography, endoscopic ultrasound, and, when possible, biopsy. Given marked differences in outcomes, the operability of tumours should be clearly identified by categories: those clearly resectable by standard means (group 1a), those requiring vascular resection but which are clearly operable (group 1b), and those of borderline operability requiring vascular resection (groups 2a and 2b). Patients who may require vascular reconstruction should be referred, before exploration, to a specialist unit. All patients should have a structured pathology report with standardised reporting of all seven surgical margins, which identifies an R0 (no tumour cells within a defined distance of the margin) if all surgical margins are clear from 1 mm. Neo-adjuvant therapy is increasingly recommended for borderline operable disease, while chemotherapy is recommended as initial therapy for patients with unresectable loco-regional pancreatic cancer. The value of adding radiation after initial chemotherapy remains uncertain. A small number of patients may be downstaged by chemoradiation, and trimodality therapy should only be considered as part of a clinical trial. Instituting these recommendations nationally will be an integral part of the process of improving quality of care and reducing geographic variation between centres in outcomes for patients.

4 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 --

5 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 --

6 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.

7 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.