Scholars@Duke
Paul Simon Jowell

Paul Simon Jowell

Professor of Medicine
Medicine, Gastroenterology
Duke Box 3662, Durham, NC 27710
03155 Hosp South, Durham, NC 27710

Selected Publications

Setting minimum standards for training in EUS and ERCP: results from a prospective multicenter study evaluating learning curves and competence among advanced endoscopy trainees.

Conference Gastrointest Endosc · June 2019 BACKGROUND AND AIMS: Minimum EUS and ERCP volumes that should be offered per trainee in "high quality" advanced endoscopy training programs (AETPs) are not established. We aimed to define the number of procedures required by an "average" advanced endoscopy ... Full text Link to item Cite

Competence in Endoscopic Ultrasound and Endoscopic Retrograde Cholangiopancreatography, From Training Through Independent Practice.

Journal Article Gastroenterology · November 2018 BACKGROUND & AIMS: It is unclear whether participation in competency-based fellowship programs for endoscopic ultrasound (EUS) and endoscopic retrograde cholangiopancreatography (ERCP) results in high-quality care in independent practice. We measured quali ... Full text Link to item Cite

Top Ten Tips Palliative Care Clinicians Should Know About Interventional Symptom Management Options When Caring for Patients with Gastrointestinal Malignancies.

Journal Article J Palliat Med · September 2018 Patients diagnosed with advanced stages of gastrointestinal (GI) malignancies are often quite symptomatic, with symptoms primarily related to anatomic sites of obstruction. Endoscopic approaches to the palliation of GI malignancies have begun to overtake s ... Full text Link to item Cite

Colonic Perforation Secondary to Retained Biliary Stent.

Journal Article Am J Gastroenterol · January 2017 Full text Link to item Cite

Image-guided fine-needle aspiration of secondary pancreatic neoplasms: A case series and review of the literature

Journal Article Pathology Case Reviews · July 10, 2015 Background Endoscopic ultrasound-guided fine-needle aspiration (FNA) has become a well-established diagnostic method for evaluation of focal lesions in the pancreas. While the majority of malignant lesions evaluated are primary pancreatic adenocarcinomas, ... Full text Cite

Rotational assisted endoscopic retrograde cholangiopancreatography in patients with reconstructive gastrointestinal surgical anatomy.

Journal Article World J Gastrointest Endosc · March 16, 2015 AIM: To evaluate the success rates of performing therapy utilizing a rotational assisted enteroscopy device in endoscopic retrograde cholangiopancreatography (ERCP) in surgically altered anatomy patients. METHODS: Between June 1, 2009 and November 8, 2012, ... Full text Link to item Cite

Endoscopic versus surgical ampullectomy: an algorithm to treat disease of the ampulla of Vater.

Journal Article Ann Surg · February 2013 OBJECTIVE: The objective of this study was to compare the effectiveness, morbidity, and mortality associated with endoscopic ampullectomy (EA) and surgical ampullectomy (SA). BACKGROUND: The proposed management of benign ampullary lesions includes local re ... Full text Link to item Cite

Interventional techniques

Chapter · January 1, 2013 Full text Cite

A multicenter, prospective study of a new fully covered expandable metal biliary stent for the palliative treatment of malignant bile duct obstruction.

Journal Article Gastroenterol Res Pract · 2013 Background and Study Aims. Endoscopic placement of self-expanding metal stents (SEMSs) is indicated for palliation of inoperable malignant biliary obstruction. A fully covered biliary SEMS (WallFlex Biliary RX Boston Scientific, Natick, USA) was assessed f ... Full text Link to item Cite

Pilot study of aprepitant for prevention of post-ERCP pancreatitis in high risk patients: a phase II randomized, double-blind placebo controlled trial.

Journal Article JOP · September 10, 2012 CONTEXT: Animal studies have demonstrated a role for substance P binding to neurokinin-1 receptor in the pathogenesis of acute pancreatitis. OBJECTIVE: Our aim was to assess the efficacy of a neurokinin-1 receptor antagonist (aprepitant) at preventing post ... Full text Link to item Cite

Intravenous synthetic secretin reduces the incidence of pancreatitis induced by endoscopic retrograde cholangiopancreatography.

Journal Article Pancreas · May 2011 OBJECTIVES: This study aimed to evaluate whether synthetic secretin is effective in reducing post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis. METHODS: This is a single academic medical center, prospective, randomized, double-blind, ... Full text Link to item Cite

For patients with predicted low risk for choledocholithiasis undergoing laparoscopic cholecystectomy, selective intraoperative cholangiography and postoperative endoscopic retrograde cholangiopancreatography is an effective strategy to limit unnecessary procedures.

Journal Article Surg Endosc · September 2009 BACKGROUND: There is debate about whether intraoperative cholangiography (IOC) should be performed routinely or selectively during laparoscopic cholecystectomy (LC) in patients with suspected choledocholithiasis. The timing of endoscopic retrograde cholang ... Full text Link to item Cite

Focal or diffuse "fullness" of the pancreas on CT. Usually benign, but EUS plus/minus FNA is warranted to identify malignancy.

Journal Article JOP · January 8, 2009 CONTEXT: The role of EUS to evaluate subtle radiographic abnormalities of the pancreas is not well defined. OBJECTIVE: To assess the yield of EUS+/-FNA for focal or diffuse pancreatic enlargement/fullness seen on abdominal CT scan in the absence of discret ... Link to item Cite

The fate of patients who undergo "preoperative" ERCP to clear known or suspected bile duct stones.

Journal Article Surg Endosc · January 2009 BACKGROUND: There is debate as to whether recurrent biliary complications are more common in patients who do not have elective cholecystectomy after endoscopic retrograde cholangiopancreatography (ERCP) management of common bile duct (CBD) stones. The aim ... Full text Link to item Cite

Staging of esophageal cancer by EUS: staging accuracy revisited.

Journal Article Gastrointest Endosc · September 2007 BACKGROUND: EUS plays an important role in the preoperative staging of esophageal cancer. Recent data have called into question the staging accuracy of EUS, particularly in patients with early disease. OBJECTIVE: Our goals were to assess our institution's ... Full text Link to item Cite

Endoscopic ultrasound-guided fine-needle aspiration for non-small cell lung cancer staging: A systematic review and metaanalysis.

Journal Article Chest · February 2007 BACKGROUND: Endoscopic ultrasound (EUS)-guided fine-needle aspiration (FNA) is a minimally invasive alternative technique for mediastinal staging of non-small cell lung cancer. A metaanalysis was performed to estimate the diagnostic accuracy of EUS-FNA for ... Full text Link to item Cite

A randomized comparison of EUS-guided FNA versus CT or US-guided FNA for the evaluation of pancreatic mass lesions.

Journal Article Gastrointest Endosc · June 2006 BACKGROUND: Diagnosing pancreatic cancer by EUS-FNA is a potentially appealing alternative to percutaneous biopsy. AIM: To compare EUS-FNA with CT or US-guided FNA for diagnosing pancreatic cancer. DESIGN: Single center, prospective, randomized, cross-over ... Full text Link to item Cite

Endoscopic ultrasound and computer tomography are inaccurate methods of classifying cystic pancreatic lesions.

Journal Article Dig Liver Dis · January 2006 Featured Publication BACKGROUND: Despite advances in imaging modalities, preoperative diagnosis of pancreatic cystic lesions remains difficult. AIM: To assess the accuracy of endoscopic ultrasound and computer tomography to preoperatively distinguish benign from potentially ma ... Full text Link to item Cite

Urgent colonoscopy for evaluation and management of acute lower gastrointestinal hemorrhage: a randomized controlled trial.

Journal Article Am J Gastroenterol · November 2005 Featured Publication OBJECTIVES: We hypothesized that early intervention in patients with lower gastrointestinal bleeding (LGIB) would improve outcomes and therefore conducted a prospective randomized study comparing urgent colonoscopy to standard care. METHODS: Consecutive pa ... Full text Link to item Cite

The yield and the predictors of esophageal pathology when upper endoscopy is used for the initial evaluation of dysphagia.

Journal Article Gastrointest Endosc · June 2005 BACKGROUND: The utility of EGD when used as an initial test for the evaluation of dysphagia is unclear. The objective was to determine the yield and the predictive factors of significant pathology when EGD is performed as the initial test to evaluate dysph ... Full text Link to item Cite

Pancreatic FNA in 1000 cases: a comparison of imaging modalities.

Journal Article Gastrointest Endosc · June 2005 Featured Publication BACKGROUND: Image-guided FNA is a popular method for evaluating pancreatic lesions, but few large studies on pancreatic FNA exist. METHODS: Cytologic material, imaging reports, and clinical follow-up information were reviewed from pancreatic FNA cases perf ... Full text Link to item Cite

EUS-guided FNA of pancreatic metastases: a multicenter experience.

Journal Article Gastrointest Endosc · May 2005 Featured Publication BACKGROUND: Metastatic lesions of the pancreas are a rare but important cause of focal pancreatic lesions. The purpose of this study is to describe the EUS features, cytologic diagnoses, and clinical impact of a cohort of patients with pancreatic metastase ... Full text Link to item Cite

Proximal migration of a 3 French pancreatic stent in a patient with pancreas divisum: suggested technique for successful retrieval.

Journal Article JOP · March 10, 2005 CONTEXT: Pancreatic stents may be placed during therapeutic ERCP for a variety of indications. One such indication is to prophylax against the development of pancreatitis following sphincterotomy of the minor papilla in patients with recurrent acute pancre ... Link to item Cite

The impact of cystic fibrosis and PSTI/SPINK1 gene mutations on susceptibility to chronic pancreatitis.

Journal Article Clin Lab Med · March 2005 Featured Publication This article reviews current concepts regarding the pathobiology of cystic fibrosis pancreatic disease. It summarizes recent studies on the relationship between CFTR mutations and pancreatitis, and it reviews several unresolved issues in the field. ... Full text Link to item Cite

Significance of histological response to preoperative chemoradiotherapy for pancreatic cancer.

Journal Article Ann Surg Oncol · March 2005 BACKGROUND: Neoadjuvant (preoperative) chemoradiotherapy (CRT) for pancreatic cancer offers theoretical advantages over the standard approach of surgery followed by adjuvant CRT. We hypothesized that histological responses to CRT would be significant progn ... Full text Link to item Cite

The role of cystic fibrosis gene mutations in determining susceptibility to chronic pancreatitis.

Journal Article Gastroenterol Clin North Am · December 2004 Featured Publication This article reviews current concepts regarding the pathobiology of cystic fibrosis pancreatic disease. It summarizes recent studies on the relationship between CFTR mutations and pancreatitis, and it reviews several unresolved issues in the field. ... Full text Link to item Cite

Yield of endoscopic ultrasound-guided fine-needle aspiration of bile duct lesions.

Journal Article Endoscopy · August 2004 Featured Publication BACKGROUND AND STUDY AIMS: It is still difficult to differentiate reliably between benign and malignant biliary tract lesions. Endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) has added to the diagnostic power of EUS for other gastrointestinal ... Full text Link to item Cite

A wolf in sheep's clothing: a non-functioning islet cell tumor of the pancreas masquerading as a microcystic (serous cystic) adenoma.

Journal Article JOP · July 2004 CONTEXT: The endosonographic appearance of a microcystic "honeycomb" lesion of the pancreas usually indicates a serous cystic adenoma. CASE REPORT: We report a case of a non-functioning islet cell tumor that has the typical microcystic "honeycomb" appearan ... Link to item Cite

Complications of pancreaticoduodenectomy after neoadjuvant chemoradiation in patients with and without preoperative biliary drainage.

Journal Article Dig Liver Dis · June 2004 BACKGROUND: It has been suggested that preoperative biliary drainage increases the risk of infectious complications of pancreaticoduodenectomy. AIMS: The aim of this study was to assess complications related to biliary stents/drains and postoperative morbi ... Full text Link to item Cite

Pancreatic duct strictures: identifying risk of malignancy.

Journal Article Ann Surg Oncol · June 2004 Featured Publication BACKGROUND: This study aimed to define PDS characteristics that predict malignancy and would thus invoke further diagnostic evaluation or aggressive treatment. METHODS: 355 cases of PDS were diagnosed by ERCP during a 7-year period at a single institution. ... Full text Link to item Cite

Outcome of endoscopic minor papillotomy in patients with symptomatic pancreas divisum.

Journal Article JOP · May 2004 Featured Publication CONTEXT: Pancreas divisum has been associated with recurrent acute pancreatitis, chronic abdominal pain without elevated pancreatic enzymes, and chronic pancreatitis. Prior studies suggest that endoscopic minor papillotomy benefits certain symptomatic panc ... Link to item Cite

The need for caution with topical anesthesia during endoscopic procedures, as liberal use may result in methemoglobinemia.

Journal Article J Clin Gastroenterol · March 2004 Featured Publication During upper gastrointestinal endoscopy, topical oropharyngeal anesthesia with lidocaine and/or benzocaine is used routinely by many endodscopists. Although such a practice is usually safe, there have been a number of reports of methemoglobinemia induced b ... Full text Link to item Cite

Pancreas Clinic - Unusual finding in a patient with pancreas divisum and abdominal pain

Journal Article MedGenMed Medscape General Medicine · December 1, 2003 Cite

Lower frequency of peritoneal carcinomatosis in patients with pancreatic cancer diagnosed by EUS-guided FNA vs. percutaneous FNA.

Journal Article Gastrointest Endosc · November 2003 Featured Publication BACKGROUND: Studies have suggested an increased risk of peritoneal seeding in patients with pancreatic cancer diagnosed by percutaneous FNA. EUS-FNA is an alternate method of diagnosis. The aim of this study was to compare the frequency of peritoneal carci ... Full text Link to item Cite

Percutaneous cholecystostomy in patients with acute cholecystitis: experience of 45 patients at a US referral center.

Journal Article J Am Coll Surg · August 2003 Featured Publication BACKGROUND: Standard treatment for acute cholecystitis is cholecystectomy, but some patients are at high risk for immediate surgery. Percutaneous cholecystostomy might be the procedure of choice in this group. We reviewed the experience of percutaneous cho ... Full text Link to item Cite

A new synthetic porcine secretin for facilitation of cannulation of the dorsal pancreatic duct at ERCP in patients with pancreas divisum: a multicenter, randomized, double-blind comparative study.

Journal Article Gastrointest Endosc · May 2003 Featured Publication BACKGROUND: Secretin, a 27 amino acid polypeptide released in response to duodenal luminal acidification, stimulates secretion of water and bicarbonate from pancreatic ductal cells. To date the only secretin available for clinical use has been a biological ... Full text Link to item Cite

Predictors of successful clinical and laboratory outcomes in patients with primary sclerosing cholangitis undergoing endoscopic retrograde cholangiopancreatography.

Journal Article Can J Gastroenterol · April 2003 UNLABELLED: Endoscopic retrograde cholangiopancreatography (ERCP) in patients with primary sclerosing cholangitis (PSC) can be a challenging and sometimes gratifying opportunity for therapeutic intervention. Although there often appears to be initial radio ... Full text Link to item Cite

Colonoscopy: practice variation among 69 hospital-based endoscopists.

Journal Article Gastrointest Endosc · March 2003 Featured Publication BACKGROUND: The medical profession, payers, and patients are interested increasingly in the quality of endoscopic procedures, including colonoscopy. The American Society for Gastrointestinal Endoscopy has recommended "report cards" by which endoscopists ma ... Full text Link to item Cite

ERCP - Methods of tissue sampling

Journal Article Techniques in Gastrointestinal Endoscopy · January 1, 2003 There are several methods for obtaining tissue samples from the pancreaticobiliary tract during endoscopic retrograde cholangio-pancreatography. Confirmation of histology is often necessary to guide subsequent therapy. In this review, several techniques ar ... Full text Cite

Extensive investigation of patients with mild elevations of serum amylase and/or lipase is 'low yield'.

Journal Article Can J Gastroenterol · December 2002 BACKGROUND: Serum amylase and lipase levels are widely used as markers of pancreatic inflammation. However, it would seem that mild elevations of amylase and lipase rarely predict significant pancreatic pathology. Pancreatic imaging tests are expensive. Th ... Full text Link to item Cite

Idiopathic pancreatitis related to CFTR: complex inheritance and identification of a modifier gene.

Journal Article J Investig Med · September 2002 Featured Publication Idiopathic chronic pancreatitis (ICP) is the leading cause of nonalcoholic chronic pancreatitis. This study examined a series of patients with ICP to determine the prevalence and role of mutations of the cystic fibrosis gene (CFTR) and of a trypsin inhibit ... Full text Link to item Cite

EUS-guided fine needle aspiration of the liver: indications, yield, and safety based on an international survey of 167 cases.

Journal Article Gastrointest Endosc · June 2002 Featured Publication BACKGROUND: The liver is a common site of metastases for various malignancies. EUS-guided fine needle aspiration (EUS-FNA) of liver masses has only been reported in small series from single centers. METHODS: A retrospective questionnaire was sent by e-mail ... Full text Link to item Cite

Gastrointestinal imaging: endoscopic ultrasound.

Journal Article Gastroenterology · May 2002 Featured Publication Full text Link to item Cite

ERCP-related perforations: risk factors and management.

Journal Article Endoscopy · April 2002 Featured Publication BACKGROUND AND STUDY AIMS: Perforations during endoscopic retrograde cholangiopancreatography (ERCP) are rare, and the management of these perforations is variable, with some patients requiring immediate surgery and others only conservative management. We ... Full text Link to item Cite

Simple pancreatic cysts: CT and endosonographic appearances.

Journal Article AJR Am J Roentgenol · April 2002 Featured Publication OBJECTIVE. This report describes the CT and endoscopic sonographic appearance of simple pancreatic cysts in three adults. CONCLUSION. Simple pancreatic cysts are typically an incidental finding in adults who have no history of pancreatic disease. The imagi ... Full text Link to item Cite

Yield of colonoscopy in patients with nonacute rectal bleeding: a multicenter database study of 1766 patients.

Journal Article Am J Gastroenterol · February 2002 Featured Publication OBJECTIVE: There are few data to guide the choice between colonoscopy and flexible sigmoidoscopy in patients with nonacute rectal bleeding, especially in younger age groups. Our aim was to determine the yield of colonoscopy for significant proximal large b ... Full text Link to item Cite

Cystic fibrosis gene mutations and pancreatitis risk: relation to epithelial ion transport and trypsin inhibitor gene mutations.

Journal Article Gastroenterology · December 2001 Featured Publication BACKGROUND & AIMS: Nonalcoholic chronic pancreatitis is usually idiopathic and often associated with cystic fibrosis gene (CFTR) mutations. It is unknown whether pancreatitis risk correlates with having 1 or 2 CFTR mutations, abnormal epithelial ion transp ... Full text Link to item Cite

Neoadjuvant chemoradiation for localized adenocarcinoma of the pancreas.

Journal Article Ann Surg Oncol · December 2001 BACKGROUND: The use of neoadjuvant (preoperative) chemoradiotherapy (CRT) for pancreatic cancer has been advocated for its potential ability to optimize patient selection for surgical resection and to downstage locally advanced tumors. This article reports ... Full text Link to item Cite

Complete response to neoadjuvant chemoradiation for rectal cancer does not influence survival.

Journal Article Ann Surg Oncol · December 2001 BACKGROUND: Up to 30% of patients with locally advanced rectal cancer have a complete clinical or pathologic response to neoadjuvant chemoradiation. This study analyzes complete clinical and pathologic responders among a large group of rectal cancer patien ... Full text Link to item Cite

Age and alarm symptoms do not predict endoscopic findings among patients with dyspepsia: a multicentre database study.

Journal Article Gut · July 2001 Featured Publication INTRODUCTION: Symptoms of dyspepsia are common but most patients do not have major upper gastrointestinal pathology. Endoscopy is recommended for dyspeptic patients over the age of 45, or those with certain "alarm" symptoms. We have evaluated the effective ... Full text Link to item Cite

Neoadjuvant chemoradiation for rectal cancer: analysis of clinical outcomes from a 13-year institutional experience.

Journal Article Ann Surg · June 2001 OBJECTIVE: To examine clinical outcomes in patients receiving neoadjuvant chemoradiation for locally advanced rectal adenocarcinoma. SUMMARY BACKGROUND DATA: Preoperative radiation therapy, either alone or in combination with 5-fluorouracil-based chemother ... Full text Link to item Cite

Staging of pancreatic cancer before and after neoadjuvant chemoradiation.

Journal Article J Gastrointest Surg · 2001 Featured Publication Neoadjuvant chemoradiation therapy is used at many institutions for treatment of localized adenocarcinoma of the pancreas. Accurate staging before neoadjuvant therapy identifies patients with distant metastatic disease, and restaging after neoadjuvant ther ... Full text Link to item Cite

Re-establishing patency of a small bore feeding tube with complete occlusion- A novel use for an ERCP catheter

Journal Article Nutrition in Clinical Practice · January 1, 2001 Background: The use of small-bore nasoen-teral feeding tubes has become a common method to provide temporary access for enteral nutrition. Occlusion is a frequent problem, which occurs in approximately 6% to 10% of patients. A reliable, reproducible, and c ... Full text Cite

A double-blind, randomized, dose response study testing the pharmacological efficacy of synthetic porcine secretin.

Journal Article Aliment Pharmacol Ther · December 2000 Featured Publication BACKGROUND: Biologically derived porcine secretin has been used as a diagnostic agent in clinical gastrointestinal practice for many years. Pure synthetic porcine secretin is now available for investigational clinical use. AIM: To compare the pharmacology ... Full text Link to item Cite

A pilot study of preoperative continuous infusion 5-fluorouracil, external microwave hyperthermia, and external beam radiotherapy for treatment of locally advanced, unresectable, or recurrent rectal cancer.

Journal Article Int J Radiat Oncol Biol Phys · June 1, 2000 Featured Publication PURPOSE: To determine the feasibility of combining external beam radiotherapy, continuous infusion 5-fluorouracil (5-FU), and external microwave hyperthermia in patients with locally advanced, unresectable, or recurrent adenocarcinoma of the rectum. METHOD ... Full text Link to item Cite

Cystic fibrosis mutations and genetic predisposition to idiopathic chronic pancreatitis.

Journal Article Med Clin North Am · May 2000 Featured Publication Idiopathic chronic pancreatitis is a leading cause of chronic pancreatitis. Work from this and other groups has shown that idiopathic chronic pancreatitis is associated with mutations of the cystic fibrosis gene (CFTR). Many idiopathic pancreatitis patient ... Full text Link to item Cite

Endoscopic ultrasound. State of the art.

Journal Article N C Med J · 2000 Featured Publication Link to item Cite

The role of ERCP in diagnosis and management of accessory bile duct leaks after cholecystectomy.

Journal Article Gastrointest Endosc · October 1999 BACKGROUND: Endoscopic retrograde cholangiopancreatography (ERCP) plays an important role in the management of bile leaks after cholecystectomy. Although most leaks occur from the cystic duct stump, clinically significant leakage from accessory bile ducts ... Full text Link to item Cite

CFTR mutations and idiopathic chronic pancreatitis

Journal Article Pediatric Pulmonology · September 1, 1999 Cite

Are mutations in the cystic fibrosis gene important in chronic pancreatitis?

Journal Article Surg Clin North Am · August 1999 Featured Publication The leading causes of chronic pancreatitis are alcohol and idiopathic pancreatitis. The importance of genetic factors in chronic pancreatitis has been uncertain. Recently, however, it was learned that many patients with idiopathic chronic pancreatitis have ... Full text Link to item Cite

Unplanned work absence following outpatient colonoscopy.

Journal Article J Clin Gastroenterol · July 1999 The authors investigated the incidence of unplanned work absence the day following outpatient colonoscopy and examined factors associated with missing work. A total of 250 patients were studied. Patient demographic information, the length of the procedure, ... Full text Link to item Cite

Endoscopic nasobiliary drain placement facilitates subsequent percutaneous transhepatic cholangiography.

Journal Article Gastrointest Endosc · February 1999 BACKGROUND: Percutaneous biliary drainage is an established alternative to ERCP for managing bile duct obstruction. Although generally safe and effective, percutaneous drainage has its risks and is technically more difficult in patients with nondilated bil ... Full text Link to item Cite

A report of a gastrinoma localized preoperatively by endoscopic ultrasound only and a review of the approach to imaging in Zollinger-Ellison syndrome.

Journal Article Dig Dis · 1999 The addition of somatostatin receptor scintigraphy and endoscopic ultrasound to the preoperative assessment of patients with Zollinger-Ellison syndrome has improved the ability to localize gastrinomas. We report a patient with Zollinger-Ellison syndrome wi ... Full text Link to item Cite

Diagnostic and therapeutic ERCP are beneficial in the management of pancreatic necrosis

Journal Article Gastrointestinal Endoscopy · December 1, 1998 There is considerable debate regarding the optimal management of pancreatic necrosis (PN). The timing and utility of endoscopic retrograde cholangiopancreatograms (ERCP) in the subset of acute pancreatitis who have PN is unclear. Objectives: It To determin ... Cite

Endoscopic retrograde pancreatography after pancreaticojejunostomy

Conference Gastrointestinal Endoscopy · December 1, 1998 Background: Retrograde surgical drainage is the treatment of choice for relieving incapacitating abdominal pain in patients (pts) with chronic pancreatitis (CP) and pancreatic duct (PD) dilatation. Lateral pancreaticojejunostomy (PJEJ) - the so-called modi ... Cite

Impact of endoscopic ultrasound on the need for ERCP in a referral center population

Journal Article Gastrointestinal Endoscopy · December 1, 1998 Background: Endoscopic ultrasound (EUS) and endoscopic retrograde cholangiopancreatography (ERCP) are useful techniques in the evaluation of patients (pts) with biliary and pancreatic diseases. Pts undergoing EUS are commonly undergoing ERCP as well. The u ... Cite

Do endoscopic interventions make a difference in primary sclerosing cholangitis? clinical and endoscopic outcomes

Journal Article Gastrointestinal Endoscopy · December 1, 1998 ERCP in patients with primary sclerosing cholangitis (PSC) can be a challenging and occasionally gratifying opportunity for therapeutic intervention. Although there often appears to be initial radiological improvement, the benefit as measured by serial est ... Cite

Pseudo-divisum of the pancreas - A source of diagnostic confusion

Journal Article Gastrointestinal Endoscopy · December 1, 1998 Background: The abrupt termination of the ventral pancreatic duct due to local pathology is sometimes mistaken for pancreas divisum. This so called "pseudodivisum" anatomy has implications for patient management, especially the timely identification of mal ... Cite

Complications of ERCP in patients with primary sclerosing cholangitis (PSC)

Journal Article Gastrointestinal Endoscopy · December 1, 1998 Patients with PSC can have intrahepatic or extrahepatic biliary strictures, or both, resulting in cholestasis and cholangitis. ERCP is commonly performed in the hope of locating a dominant extrahepatic or hilar stricture amenable to endoscopic therapy. The ... Cite

Placement of a nasobiliary drain during ERCP facilitates subsequent percutaneous transhepatic cholangiography

Journal Article Gastrointestinal Endoscopy · December 1, 1998 Background: The management of patients with complex biliary pathology often requires the combined efforts of biliary endoscopists and vascular radiologists. Percutaneous access with placement of stents or drains is often needed if endoscopic retrograde cho ... Cite

Predictors of successful clinical, radiological and laboratory outcomes in patients with primary sclerosing cholangitis (PSC) undergoing ERCP

Journal Article Gastrointestinal Endoscopy · December 1, 1998 ERCP is commonly performed in patients with known PSC in hopes of delineating dominant strictures amenable to endoscopic therapy. Knowledge of certain factors may be important in predicting successful management of these patients. Objective: To determine w ... Cite

Duration of colonoscopy: The effect of trainee presence on procedure time

Journal Article Gastrointestinal Endoscopy · December 1, 1998 Recent new Medicare regulations for teaching physicians have focused attention on the additional costs associated with training. For endoscopists, a major component of this teaching effort is the extended procedure time associated with supervision of train ... Cite

Gastroenterology trainee miss-rate for colon polyps: A prospective study of tandem colonoscopic examinations

Journal Article Gastrointestinal Endoscopy · December 1, 1998 Background: Determination of a safe follow-up period following identification of adenomatous polyps is critically dependent on the quality and thoroughness of the first colonoscopy. We performed a prospective study examining the miss-rate of colonoscopy fo ... Cite

Yield of upper endoscopy in dyspepsia; A multicenter database study

Journal Article Gastrointestinal Endoscopy · December 1, 1998 Upper endoscopy is used frequently for the investigation of patients with upper abdominal symptoms. Efficient utilization requires understanding of the potential yield in different clinical contexts. Five centers used a common "GI-Trac" database to documen ... Cite

Relation between mutations of the cystic fibrosis gene and idiopathic pancreatitis.

Journal Article N Engl J Med · September 3, 1998 Featured Publication BACKGROUND: It is unknown whether genetic factors predispose patients to idiopathic pancreatitis. In patients with cystic fibrosis, mutations of the cystic fibrosis transmembrane conductance regulator (CFTR) gene typically cause pulmonary and pancreatic in ... Full text Link to item Cite

Endoscopic sphincterotomy for stones by experts is safe, even in younger patients with normal ducts.

Journal Article Ann Surg · February 1998 OBJECTIVE: To provide current information on the risks of endoscopic sphincterotomy for stone. SUMMARY BACKGROUND DATA: In recent years (since the popularity of laparoscopic cholecystectomy), endoscopic sphincterotomy has been used increasingly for the man ... Full text Link to item Cite

Hospital credentialing for laparoscopic cholecystectomy: is stricter better?

Journal Article Clin Perform Qual Health Care · 1998 OBJECTIVE: Hospital credentialing standards for laparoscopic cholecystectomy were established to improve surgical outcomes, but standards vary by hospital. We hypothesized that more stringent credentialing would result in better outcomes. DESIGN: Univariat ... Link to item Cite

Gastroenterology. Lasers come of age.

Journal Article Lancet · December 20, 1997 Full text Link to item Cite

Indications for and results of urgent ERCP

Journal Article Gastrointestinal Endoscopy · January 1, 1997 Background: Cholangitis, severe gallstone pancreatitis, and bile duct injuries are indications for urgent endoscopic retrograde cholangio-pancreatography (ERCP). Performing ERCP "out of hours" has its problems as support personnel may not be available and ... Full text Cite

Accessory bile duct leaks after cholecystectomy: Diagnosis and treatment

Journal Article Gastrointestinal Endoscopy · January 1, 1997 Background: Postoperative bile leak is a common indication for ERCP after cholecystectomy. Aberrant or "accessory" bile duct leaks (ABDL) are difficult to recognize; appropriate treatment is often delayed. The purpose of this study is to review the managem ... Full text Cite

ERCP under general anesthesia (GA): Indications and outcomes

Journal Article Gastrointestinal Endoscopy · January 1, 1997 Background: The safety and efficacy of GA for ERCP has not been studied systematically. We describe our referral center experience with the use of GA for ERCP. Methods: Patients undergoing ERCP with GA were identified in our computerized database; their me ... Full text Cite

Evidence-based algorithm for management of biliary leaks following laparoscopic cholecystectomy (LC)

Journal Article Gastrointestinal Endoscopy · January 1, 1997 In the era of LC, ERCP is the diagnostic and therapeutic modality of choice for post-up bile leaks. The existing algorithm has to be modified when leaks (a) fail to resolve with stenting or sphx or (b) cannot be localized by ERCP. The following algorithm r ... Full text Cite

ERCP after Roux-en-Y gastrojejunostomy rarely succeeds: Could MRCP be the answer?

Journal Article Gastrointestinal Endoscopy · January 1, 1997 Background: ERCP has an expected success rate of greater than 90% but is technically difficult in patients with post-surgical anatomy. It is especially challenging after Roux-en-Y gastrojejunostomy, as the papilla has to be reached through the Roux limb. W ... Full text Cite

Pancreatic ductal (PD) stones in patients with pancreas divisum: Success of removal and symptomatic improvement: multi-center study

Journal Article Gastrointestinal Endoscopy · January 1, 1997 PD stones can cause acute exacerbation of pancreatitis or chronic abdominal pain. Successful removal of PD stones from the duct of Wirsung (ventral duct) has been achieved in over 70% with symptomatic improvement in most pts. The anatomic variant, pancreas ... Full text Cite

Quantitative assessment of procedural competence. A prospective study of training in endoscopic retrograde cholangiopancreatography.

Journal Article Ann Intern Med · December 15, 1996 Featured Publication BACKGROUND: Endoscopic retrograde cholangiopancreatography (ERCP) is a technically demanding procedure that can cause substantial complications. Competence in performing ERCP and the learning curve for achieving competence are poorly understood. OBJECTIVE: ... Full text Link to item Cite

Patient-controlled analgesia for conscious sedation during endoscopic retrograde cholangiopancreatography: a randomized controlled trial.

Journal Article Gastrointest Endosc · May 1996 Featured Publication BACKGROUND: Adequate comfort is essential to patients undergoing invasive procedures. This study was designed to evaluate whether patient-controlled analgesia could improve sedation for ERCP. METHODS: Patients were randomized to receive standard sedation ( ... Full text Link to item Cite

Predictors of improvement following endoscopic management of chronic pancreatitis

Conference Gastrointestinal Endoscopy · 1996 Background: Endoscopic therapy is an accepted treatment for pain in chronic pancreatitis, in addition to traditional management. However, guidelines for selecting treatment options have yet to be established. This study addresses 2 questions: (a) which pat ... Cite

Endoscopic therapy for pancreatic fistulae

Conference Gastrointestinal Endoscopy · 1996 INTRODUCTION: Case reports and small series have indicated that endoscopic therapy for pancreatic fistulae (PF) may be successful. This series reviews the experience with PF at a tertiary care referral center. METHODS: A retrospective review of the DUMC en ... Cite

Prediction of post-ERCP related pancreatitis

Journal Article Gastrointestinal Endoscopy · January 1, 1996 INTRODUCTION: The etiology of post ERCP pancreatitis is unknown, although numerous associations have been postulated. Identification of specific risk factors may lead to insights in etiology and prevention of this common complications. METHODS: Data on 6,0 ... Full text Cite

The role of ERCP in the management of biliary leaks following laparoscopic cholecystectomy (LC)

Conference Gastrointestinal Endoscopy · 1996 Background: Despite its distinct advantages and overall safety, LC has its complications, including biliary leak. The role of ERCP in the diagnosis and treatment of post-LC bile leaks is still evolving. We review a tertiary referral center experience of ER ... Cite

A comparison of Magnetic Resonance Cholangiopancreatography (MRCP) and ERCP in the evaluation of chronic pancreatitis

Journal Article Gastrointestinal Endoscopy · January 1, 1996 Introduction: Magnetic Resonance Cholangiopancreatography (MRCP) is a novel application of MRI which may replace diagnostic ERCP in many cases. The indications for and diagnostic yield of MRCP remain to be elucidated. We performed a comparison of MRCP and ... Full text Cite

Validation of an endoscopic retrograde cholangiopancreatography (ERCP)-based algorithm for the management of pancreatic pseudocysts (PP)

Conference Gastrointestinal Endoscopy · 1996 Background: Our previously published algorithm for management of PP1 assumed that (a) recurrence rates after percutaneous management are related to the presence of pancreatic duct (PD) obstruction or PP communication with the PD and (b) surgical management ... Cite

At least 180 ERCPs are needed to attain competence in diagnostic and therapeutic ERCP

Journal Article Gastrointestinal Endoscopy · January 1, 1996 Aim: To evaluate the number of ERCPs gastroenterology fellows should perform to achieve competency. Methods: From July 1993 to June 1995 consecutive ERCPs performed by fellows were graded on a standardized evaluation form. Success in specific technical com ... Full text Cite

ERCP biliary stenting practice; A prospective multicenter study

Journal Article Gastrointestinal Endoscopy · January 1, 1996 Methods: Six centers offering comprehensive ERCP services used the GI-Trac database prospectively to analyze and compare endoscopy practices. There were 3 University referral centers (Medical University of SC; University of CA, Davis; McGill University, Mo ... Full text Cite

Proximal migration of biliary stents: attempted endoscopic retrieval in forty-one patients.

Journal Article Gastrointest Endosc · December 1995 BACKGROUND: Proximal migration of a biliary stent is an uncommon event, but its management can present a technical challenge to the therapeutic endoscopist. METHODS: We reviewed the methods that have been used for retrieval of proximally migrated biliary s ... Full text Link to item Cite

Esophageal perforation after ingestion of colon lavage solution.

Journal Article Am J Gastroenterol · November 1995 Link to item Cite

Novel methods for endoscopic training.

Journal Article Gastrointest Endosc Clin N Am · April 1995 The development of past, present, and future endoscopic training methods is described. A historical perspective of endoscopy training guidelines and devices is used to demonstrate support for the use of novel endoscopic training techniques. Computer simula ... Link to item Cite

Assessment of pancreatic duct strictures.

Journal Article Gastrointest Endosc Clin N Am · January 1995 It should be fairly clear that the evaluation of pancreatic duct strictures is complex. Short of surgical resection, there is no gold standard that will provide an etiological diagnosis unless cancer is found on a biopsy specimen. To complicate matters fur ... Link to item Cite

ERCP training in the 1990s. Time for new ideas.

Journal Article Gastrointest Endosc Clin N Am · April 1994 Endoscopic retrograde cholangiopancreatography (ERCP) is one of the most demanding procedures performed by gastrointestinal endoscopists; however, surprisingly little is known about how the necessary hand-eye coordination and cognitive skills are acquired. ... Link to item Cite

Non-operative management of a common bile duct injury sustained during cholecystectomy in a morbidly obese patient. (Non-operative repair of CBD injury).

Journal Article HPB Surg · 1994 A 29 year old morbidly obese patient suffered injury to his common bile duct during cholecystectomy. Subsequent access to the biliary tree was obtained by using a long heavy gauge needle after first opacifying the system with contrast injection through a n ... Full text Link to item Cite

Teaching by endoscopy simulation.

Journal Article Endoscopy · July 1991 Full text Link to item Cite

Use of computer graphics simulation for teaching of flexible sigmoidoscopy.

Journal Article Endoscopy · May 1991 The concept of simulation training in endoscopy is now well-established. The systems currently under development employ either computer graphics simulation or interactive video technology; each has its strengths and weaknesses. A flexible sigmoidoscopy tra ... Full text Link to item Cite

The effect of high-dose salmon calcitonin on bone mineral metabolism in the normal rat.

Journal Article Calcif Tissue Int · January 1990 The paucity of information on the effect of long-term high-dose salmon calcitonin administration on normal bone mineral metabolism and histology prompted an investigation of the influence of high-dose synthetic calcitonin in the rat. Serum ionized calcium, ... Full text Link to item Cite

The response of circulating parameters of bone mineral metabolism to ethanol- and EDTA-induced hypocalcemia in the rat.

Journal Article Bone Miner · January 1990 The mechanism of the acute hypocalcemia that follows acute ethanol administration has not been established. Measurements of parathyroid hormone (PTH) performed during this hypocalcemia reveal conflicting results. We compared the response of ionized calcium ... Full text Link to item Cite

The effect of chronic caffeine administration on serum markers of bone mineral metabolism and bone histomorphometry in the rat.

Journal Article Calcif Tissue Int · November 1988 Caffeine has been cited as a risk factor for osteoporosis in humans. In rats, caffeine increases calcium absorption and excretion and raises parathyroid hormone (iPTH) levels. This study investigated the effect of chronic caffeine administration on bone hi ... Full text Link to item Cite

Alteration in osteoblast activity and nutritional vitamin-D deficiency in non-hypercalcemic malignancy.

Journal Article Calcif Tissue Int · January 1988 Featured Publication The biochemical parameters of bone mineral metabolism in patients with nonhypercalcemic malignancy have not been extensively investigated. Therefore, a group of 29 such patients with different types of malignancy was studied. Ten patients received corticos ... Full text Link to item Cite

1,25-Dihydroxyvitamin D3 modulates glucocorticoid-induced alteration in serum bone Gla protein and bone histomorphometry.

Journal Article Endocrinology · February 1987 Featured Publication Glucocorticoid excess is associated with alterations in the vitamin D endocrine system. The aim of this study was to assess change in serum bone Gla protein (BGP) after low and high dose cortisone acetate treatment and to assess whether these alterations a ... Full text Link to item Cite