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Elizabeth Rajan

Publications and source records attributed to Elizabeth Rajan.

At least 19 recordsLinked to original sources
PubMed2007

Endoscopic full-thickness closure of large gastric perforations by use of tissue anchors.

BACKGROUND: A flexible needle-catheter tissue-anchoring device was developed to accomplish full-thickness tissue apposition of the GI wall. The aim of this study was to identify the performance of this device for repair of large iatrogenic gastric perforations in a porcine model. OBJECTIVES: Six pigs. DESIGN: Short-term survival animal study. SETTINGS: Pigs were studied while they were under general anesthesia. Device performance in differing gastric locations and wall thicknesses was assessed by 2 perforations more than 2 cm in size created for each pig along the greater curvature and the anterior wall. INTERVENTIONS: Each perforation was closed by parallel placement of tissue anchor sets sequentially along the length of the perforation. MAIN OUTCOME MEASUREMENTS: One week follow-up endoscopy and necropsy were performed. RESULTS: Twelve perforations were closed with the 48 tissue anchor sets. All animals survived for 1 week without clinical complications. Follow-up endoscopy and necropsy revealed that all tissue anchors remained with firmly held sutures and sealed perforations. CONCLUSIONS: Full-thickness closure with a new tissue-anchoring device simply and successfully repaired large iatrogenic gastric perforations.

Animals↗
PubMed2006

Preoperative diagnosis of extrapancreatic neural invasion in pancreatic cancer.

BACKGROUND & AIMS: Pancreatic cancer recurs in most patients after resection with curative intent. Recurrence is particularly common in patients with extrapancreatic neural invasion (EPNI), the presence of which correlates with poor prognosis. Macroscopic EPNI may be detected with conventional noninvasive imaging and endoscopic ultrasound (EUS) imaging, but microscopic EPNI has required postoperative pathologic examination of surgical specimens. We report the preoperative diagnosis of cancer infiltration into celiac ganglia. We hypothesized that microscopic pancreatic cancer metastasis to neural ganglia can be detected by EUS-guided biopsy examination. METHODS: We performed a retrospective review of patients with pancreatic cancer undergoing EUS in whom celiac ganglia were sampled to exclude malignant infiltration. RESULTS: Six patients with pancreatic cancer underwent EUS-guided fine-needle aspiration or trucut biopsy examination of presumed celiac ganglia. Metastatic cancer was found in ganglia of 2 patients. Specimen review identified adenocarcinoma and neural tissue in the absence of lymphocytes. At laparoscopy, 1 of the 2 patients with positive celiac biopsy specimens also had several unexpected peritoneal metastatic deposits. The other patient was considered to have locally advanced unresectable disease. Both patients are receiving supportive care. CONCLUSIONS: EPNI may be shown preoperatively in patients with pancreatic cancer using EUS-guided sampling of celiac ganglia. A preoperative diagnosis of EPNI has the potential to improve staging accuracy and patient outcomes.

Adenocarcinoma↗
PubMed2006

Diagnostic yield and therapeutic impact of double-balloon enteroscopy in a large cohort of patients with obscure gastrointestinal bleeding.

OBJECTIVES: Double-balloon enteroscopy (DBE) is a novel endoscopic technique developed to investigate small bowel disease. There are limited available data on its impact in the diagnosis and management of obscure gastrointestinal bleeding (OGIB). The aim of this study was to evaluate the diagnostic yield and therapeutic impact of DBE in the management of patients with OGIB. METHODS: This study is a retrospective analysis of patients referred to our hospital from December 2003 to January 2005 for the investigation of overt or occult OGIB who underwent DBE after negative upper endoscopy and colonoscopy. Demographic, clinical, procedural, and outcome data were collected for analysis. RESULTS: One hundred fifty-two patients (73 women and 79 men) were studied, with a mean age of 48.2 yr. Seventeen patients presented with occult OGIB while 135 patients had overt OGIB. A total of 191 DBEs was performed. Antegrade and retrograde approaches were performed in 60 and 53 patients, respectively, and 39 patients had a combination of both routes. DBE demonstrated a potential bleeding site in 115 (75.7%) patients (102 overt, 13 occult). The more common abnormalities detected were small bowel tumors (39.1%) and angioectasia (30.4%). DBE altered management in 83.5% of patients with positive findings. Follow-up was obtained on 119 patients (mean 16 months, range 8-23 months). Of the 95 patients with follow-up and a positive DBE finding, 85 (89%) had no further rebleeding. The procedure was well tolerated with 23 patients (15.1%) experiencing mild self-limited bleeding during the procedure. CONCLUSIONS: DBE appears to have a high diagnostic yield and therapeutic impact in patients with OGIB with previously negative upper endoscopy and colonoscopy.

Adolescent↗
PubMed2006

Neural ganglia visualized by endoscopic ultrasound.

OBJECTIVES: To describe visualization of gastrointestinal neural ganglia by endoscopic ultrasound (EUS). METHODS: We retrospectively identified patients in whom neural ganglia were visualized during EUS and the diagnosis of ganglion confirmed by EUS guided fine needle aspiration (FNA) cytology. RESULTS: Ten patients were identified. Celiac ganglia were visualized in nine, and a perirectal ganglion was visualized in one. Ganglia appeared as discrete hypoechoic structures, often with associated hypoechoic threads that may represent neural rami. Aspiration of ganglia yielded scant material and caused transient pain. Ganglia were best visualized with linear array echoendoscopes. Celiac ganglia (but not the perirectal ganglion) were retrospectively identified on computed tomography scans. CONCLUSIONS: Gastrointestinal neural ganglia can be imaged by EUS and their identity confirmed by EUS FNA.

Adult↗
PubMed2006

Esophageal dilation.

Explore the source record for details and available documents.

Deglutition Disorders↗
PubMed2006

Pilot study of the porcine uterine horn as an in vivo appendicitis model for development of endoscopic transgastric appendectomy.

BACKGROUND: Iatrogenic inflammation of the porcine uterine horn may serve as an in vivo appendicitis model for the development of endoscopic transgastric appendectomy. OBJECTIVE: Five female pigs. STUDY DESIGN: Animal study. SETTINGS: General anesthesia. MAIN OUTCOME MEASUREMENTS: Anatomical appearance and technical feasibility. INTERVENTIONS: Three pigs were used to identify an injectable material that would inflame the uterine horn, and 2 pigs were used for a pilot appendectomy. Three types of materials were individually injected into the bilateral uterine horns, and the ideal material to inflame the uterine horn was injected into the right uterine horn for the last 2 pigs. After 24 hours, the injected uterine horns of the first 3 pigs were assessed and a pilot appendectomy was performed in the last 2 pigs. RESULTS: Ethanolamine oleate (EO) injected uterine horns demonstrated similarities to the inflamed human appendix. Simulations of the appendectomy were successfully performed by using the EO model. LIMITATIONS: Suboptimal existing tools. CONCLUSIONS: This preliminary study demonstrated the technical feasibility to create a model for acute appendicitis by using the porcine uterine horn and transgastric appendectomy.

Animals↗
PubMed2005

Prospective study of a Trucut needle for performing EUS-guided biopsy with EUS-guided FNA rescue.

BACKGROUND: EUS-guided FNA (EUS-FNA) is an accurate technique for sampling extraintestinal masses and lymph nodes. The use of a Trucut needle to perform EUS-guided biopsy (EUS-TCB) may improve the results or simplify the procedure. To date, few studies have prospectively assessed the performance and the safety of EUS-TCB. METHODS: Patients with a known or a suspected malignancy referred for a diagnostic and/or staging EUS examination were enrolled in a prospective study. EUS-guided biopsy was performed first with a 19-gauge Trucut needle. If the Trucut failed to obtain an adequate sample or when the "in room" touch preparation was benign, EUS-FNA was performed with a standard 22-gauge FNA needle. The objective of the study was to assess the yield of detection of malignancy and the safety of EUS-TCB in patients with known or suspected malignancies and to investigate if EUS-FNA has a role for rescue in cases of Trucut failure. OBSERVATIONS: Thirty-nine lesions underwent EUS-TCB in 30 patients. Sufficient follow-up was available for all patients. By using EUS-TCB, we were able to obtain a sample for diagnosis in all but 3 patients (one pancreatic mass and two lymph nodes) in which technical problems arose. In these patients, the diagnosis was obtained in two cases by EUS-FNA and in the other one by EUS-TCB from the primary pancreatic tumor. The yield of detection of malignancy for EUS-TCB was 84%. No complications were recorded in any patients at 1 and 7 days of follow-up. The sample size is limited to generalize conclusions. CONCLUSIONS: EUS-TCB is a safe and an accurate procedure to obtain a histologic diagnosis in patients with known or suspected malignancies. EUS-FNA can serve as a rescue technique in cases of Trucut failure.

Adult↗
PubMed2005

Endoscopic treatments for obesity: past, present and future.

Obesity is recognized as a serious, chronic illness affecting all ages. The cause for obesity is multi-factorial, which makes successful management complex and challenging. Meaningful weight loss is frequently difficult to achieve, particularly when the goal is not merely to lose weight but to maintain this loss. The efficacy of future endoscopic approaches needs to be validated through well-designed controlled studies, and verification of safety is essential. Endoluminal therapies must have a sound physiologic basis for their development. The availability of specialized radionuclide imaging of gastric capacity and accommodation provide a useful tool in constructing interventions. Endotherapy is likely best suited for nonmorbid obese individuals with BMI ranging from 30 to 39 or as a budge to bariatric surgery. This specific BMI range has been targeted by the National Institutes of Health for emerging technologies. Presurgical weight loss to reduce surgical risk is another potential target group. Regardless of which endoscopic methods prevail, patients will continue to require a comprehensive, multi-modality management approach to this complex disease.

Bariatrics↗