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Pichamol Jirapinyo 6 Articles
Effect of Aspiration Therapy on Obesity-Related Comorbidities: Systematic Review and Meta-Analysis
Pichamol Jirapinyo, Diogo T. H. de Moura, Laura C. Horton, Christopher C. Thompson
Clin Endosc 2020;53(6):686-697.   Published online February 28, 2020
DOI: https://doi.org/10.5946/ce.2019.181
AbstractAbstract PDFPubReaderePub
Background
/Aims: Aspiration therapy (AT) involves endoscopic placement of a gastrostomy tube with an external device that allows patients to drain 30% of ingested calories after meals. Its efficacy for inducing weight loss has been shown. This study aimed to assess the effect of AT on obesity-related comorbidities.
Methods
A meta-analysis of studies that assessed AT outcomes was conducted through December 2018. Primary outcomes were changes in comorbidities at 1 year following AT. Secondary outcomes were the amount of weight loss at up to 4 years and pooled serious adverse events (SAEs).
Results
Five studies with 590 patients were included. At 1 year, there were improvements in metabolic conditions: mean difference (MD) in systolic blood pressure: -7.8 (-10.7 – -4.9) mm Hg; MD in diastolic blood pressure: -5.1 (-7.0 – 3.2) mm Hg; MD in triglycerides: -15.8 (-24.0 – -7.6) mg/dL; MD in high-density lipoprotein: 3.6 (0.7–6.6) mg/dL; MD in hemoglobin A1c (HbA1c): -1.3 (-1.8 – -0.8) %; MD in aspartate transaminase: -2.7 (-4.1 – -1.3) U/L; MD in alanine transaminase: -7.5 (-9.8 – -5.2) U/L. At 1 (n=218), 2 (n=125), 3 (n=46), and 4 (n=27) years, the patients experienced 17.8%, 18.3%, 19.1%, and 18.6% total weight loss (TWL), corresponding to 46.3%, 46.2%, 48.0%, and 48.7% excess weight loss (EWL) (p<0.0001 for all). Subgroup analysis of 2 randomized controlled trials (n=225) showed that AT patients lost more weight than did controls by 11.6 (6.5–16.7) %TWL and 25.6 (16.0–35.3) %EWL and experienced greater improvement in HbA1c and alanine transaminase by 1.3 (0.8–1.8) % and 9.0 (3.9–14.0) U/L. The pooled SAE rate was 4.1%.
Conclusions
Obesity-related comorbidities significantly improved at 1 year following AT. Additionally, a subgroup of patients who continued to use AT appeared to experience significant weight loss that persisted up to at least 4 years.

Citations

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    Willian Ferreira Igi, Victor Lira de Oliveira, Ayah Matar, Diogo Turiani Hourneaux de Moura
    Clinical Endoscopy.2024; 57(3): 309.     CrossRef
  • Updates in Endoscopic Bariatric and Metabolic Therapies
    Hammad Qureshi, Naba Saeed, Manol Jovani
    Journal of Clinical Medicine.2023; 12(3): 1126.     CrossRef
  • The Role Bariatric Surgery and Endobariatric Therapies in Nonalcoholic Steatohepatitis
    Aaron Yeoh, Robert Wong, Ashwani K. Singal
    Clinics in Liver Disease.2023; 27(2): 413.     CrossRef
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    Rama Hritani, Mahmoud Al Rifai, Anurag Mehta, Charles German
    Obesity Pillars.2023; 7: 100069.     CrossRef
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    Maheeba Abdulla, Nafeesa Mohammed, Jehad AlQamish
    World Journal of Gastroenterology.2023; 29(40): 5526.     CrossRef
  • Endoscopic removal of a weight-loss device with stoma closure using a tack-and-suture device
    Areebah Waseem, Joseph Wawrzynski, Daniel B. Maselli, Ashley Kucera, Chase Wooley, Christopher McGowan
    VideoGIE.2023; 8(11): 441.     CrossRef
  • Effect of Endoscopic Bariatric and Metabolic Therapies on Nonalcoholic Fatty Liver Disease: A Systematic Review and Meta-analysis
    Pichamol Jirapinyo, Thomas R. McCarty, Russell D. Dolan, Raj Shah, Christopher C. Thompson
    Clinical Gastroenterology and Hepatology.2022; 20(3): 511.     CrossRef
  • Endobariatrics: well past infancy and maturing rapidly
    Shreesh Shrestha, Esha Shrestha, Tilak Shah
    Current Opinion in Gastroenterology.2022; 38(6): 592.     CrossRef
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    Abhishek Shenoy, Allison R Schulman
    Gastroenterology Report.2022;[Epub]     CrossRef
  • Various Novel and Emerging Technologies in Endoscopic Bariatric and Metabolic Treatments
    Hee Kyong Na, Diogo Turiani Hourneaux De Moura
    Clinical Endoscopy.2021; 54(1): 25.     CrossRef
  • Endoscopic Sleeve Gastroplasty (ESG) for High-Risk Patients, High Body Mass Index (> 50 kg/m2) Patients, and Contraindication to Abdominal Surgery
    Renjie Li, Wilfried Veltzke-Schlieker, Andreas Adler, Maximilian Specht, Wael Eskander, Mahmoud Ismail, Harun Badakhshi, Manoel Passos Galvao, Ricardo Zorron
    Obesity Surgery.2021; 31(8): 3400.     CrossRef
  • Obesity Primer for the Practicing Gastroenterologist
    Pichamol Jirapinyo, Christopher C. Thompson
    American Journal of Gastroenterology.2021; 116(5): 918.     CrossRef
  • Bariatric and metabolic endoscopy: impact on obesity and related comorbidities
    Amit Mehta, Reem Z. Sharaiha
    Therapeutic Advances in Gastrointestinal Endoscopy.2021; 14: 263177452110191.     CrossRef
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    Andrew Kim, Joshua A. Spiro, Thomas J. Hatzidais, Norman D. Randolph, Rosie Q. Li, Diana Ayubcha, Mark S. Weiss
    Current Opinion in Anaesthesiology.2021; 34(4): 490.     CrossRef
  • Preparing for the NASH Epidemic: A Call to Action
    Fasiha Kanwal, Jay H. Shubrook, Zobair Younossi, Yamini Natarajan, Elisabetta Bugianesi, Mary E. Rinella, Stephen A. Harrison, Christos Mantzoros, Kim Pfotenhauer, Samuel Klein, Robert H. Eckel, Davida Kruger, Hashem El-Serag, Kenneth Cusi
    Gastroenterology.2021; 161(3): 1030.     CrossRef
  • Preparing for the NASH epidemic: A call to action
    Fasiha Kanwal, Jay H. Shubrook, Zobair Younossi, Yamini Natarajan, Elisabetta Bugianesi, Mary E. Rinella, Stephen A. Harrison, Christos Mantzoros, Kim Pfotenhauer, Samuel Klein, Robert H. Eckel, Davida Kruger, Hashem El-Serag, Kenneth Cusi
    Metabolism.2021; 122: 154822.     CrossRef
  • Preparing for the NASH epidemic: A call to action
    Fasiha Kanwal, Jay H. Shubrook, Zobair Younossi, Yamini Natarajan, Elisabetta Bugianesi, Mary E. Rinella, Stephen A. Harrison, Christos Mantzoros, Kim Pfotenhauer, Samuel Klein, Robert H. Eckel, Davida Kruger, Hashem El‐Serag, Kenneth Cusi
    Obesity.2021; 29(9): 1401.     CrossRef
  • Preparing for the NASH Epidemic: A Call to Action
    Fasiha Kanwal, Jay H. Shubrook, Zobair Younossi, Yamini Natarajan, Elisabetta Bugianesi, Mary E. Rinella, Stephen A. Harrison, Christos Mantzoros, Kim Pfotenhauer, Samuel Klein, Robert H. Eckel, Davida Kruger, Hashem El-Serag, Kenneth Cusi
    Diabetes Care.2021; 44(9): 2162.     CrossRef
  • Endobariatrics and Metabolic Endoscopy: Can We Solve the Obesity Epidemic with Our Scope?
    Jad Farha, Shahem Abbarh, Zadid Haq, Mohamad I. Itani, Andreas Oberbach, Vivek Kumbhari, Dilhana Badurdeen
    Current Gastroenterology Reports.2020;[Epub]     CrossRef
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Endoscopic Ultrasound Fine-Needle Aspiration versus Fine-Needle Biopsy for Lymph Node Diagnosis: A Large Multicenter Comparative Analysis
Diogo Turiani Hourneaux de Moura, Thomas R. McCarty, Pichamol Jirapinyo, Igor Braga Ribeiro, Galileu Ferreira Ayala Farias, Marvin Ryou, Linda S. Lee, Christopher C. Thompson
Clin Endosc 2020;53(5):600-610.   Published online December 3, 2019
DOI: https://doi.org/10.5946/ce.2019.170
AbstractAbstract PDFPubReaderePub
Background
/Aims: Endoscopic ultrasound fine-needle aspiration (EUS-FNA) is preferred for sampling of lymph nodes (LNs) adjacent to the gastrointestinal wall; however, fine-needle biopsy (FNB) may provide improved diagnostic outcomes. This study aimed to evaluate the comparative efficacy and safety of FNA versus FNB for LN sampling.
Methods
This was a multicenter retrospective study of prospectively collected data to evaluate outcomes of EUS-FNA and EUS-FNB for LN sampling. Characteristics analyzed included sensitivity, specificity, accuracy, the number of needle passes, diagnostic adequacy of rapid on-site evaluation (ROSE), cell-block analysis, and adverse events.
Results
A total of 209 patients underwent EUS-guided LN sampling. The mean lesion size was 16.22±8.03 mm, with similar sensitivity and accuracy between FNA and FNB ([67.21% vs. 75.00%, respectively, p=0.216] and [78.80% vs. 83.17%, respectively, p=0.423]). The specificity of FNB was better than that of FNA (100.00% vs. 93.62%, p=0.01). The number of passes required for diagnosis was not different. Abdominal and peri-hepatic LN location demonstrated FNB to have a higher sensitivity (81.08% vs. 64.71%, p=0.031 and 80.95% vs. 58.33%, p=0.023) and accuracy (88.14% vs. 75.29%, p=0.053 and 88.89% vs. 70.49%, p=0.038), respectively. ROSE was a significant predictor for accuracy (odds ratio, 5.16; 95% confidence interval, 1.15–23.08; p=0.032). No adverse events were reported in either cohort.
Conclusions
Both EUS-FNA and EUS-FNB are safe for the diagnosis of LNs. EUS-FNB is preferred for abdominal LN sampling. EUSFNA+ ROSE was similar to EUS-FNB alone, showing better diagnosis for EUS-FNB than traditional FNA. While ROSE remained a significant predictor for accuracy, due to its poor availability in most centers, its use may be limited to cases with previous inconclusive diagnoses.

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Validation of a Novel Endoscopic Retrograde Cholangiopancreatography Cannulation Simulator
Pichamol Jirapinyo, Andrew C. Thompson, Hiroyuki Aihara, Marvin Ryou, Christopher C. Thompson
Clin Endosc 2020;53(3):346-354.   Published online February 17, 2020
DOI: https://doi.org/10.5946/ce.2019.105
AbstractAbstract PDFSupplementary MaterialPubReaderePub
Background
/Aims: Endoscopic retrograde cholangiopancreatography (ERCP) requires a unique skill set. Currently, there is no objective methodology to assess and train a professional to perform ERCP. This study aimed to develop and validate a novel ERCP simulator.
Methods
The simulator consists of papillae presenting different anatomy and positioned in varied locations. Deep cannulation of the pancreatic duct, followed by the bile duct, was performed. The time allotted was 5 minutes. The content validity indexes (CVIs) for realism, relevance, and representativeness were calculated. Correlation between ERCP experience and simulator score was determined.
Results
Twenty-three participants completed the simulation. The CVIs for realism were orientation of duodenoscope to papilla (1.00), angulation of papillotome to achieve cannulation (0.71), and haptic feedback during cannulation (0.80). The CVIs for relevance were use of elevator (1.00), wheels to achieve en face orientation (1.00), and papillotome for selective cannulation (1.00). Regarding CVI for representativeness, the results were as follows: basic cannulation (0.83), papilla locations (0.83), and papilla anatomies (0.80). The novice, intermediate, and experienced groups scored 6.7±8.7, 30.0±16.3, and 74.4±43.9, respectively (p<0.0001). There was a strong correlation between the ERCP experience level and the individual’s simulator score (Pearson value of 0.77, R2 of 0.60).
Conclusions
This simulator appears to be realistic, relevant, and representative of ERCP cannulation techniques. Additionally, it is effective at objectively assessing basic ERCP skills by differentiating scores based on clinical experience.

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Role of Cardiac Septal Occluders in the Treatment of Gastrointestinal Fistulas: A Systematic Review
Diogo Turiani Hourneaux De Moura, Alberto Baptista, Pichamol Jirapinyo, Eduardo Guimarães Hourneaux De Moura, Christopher Thompson
Clin Endosc 2020;53(1):37-48.   Published online July 9, 2019
DOI: https://doi.org/10.5946/ce.2019.030
AbstractAbstract PDFPubReaderePub
Treating gastrointestinal (GI) fistulas endoscopically is challenging owing to an established epithelial tract. The variety of endoscopic approaches is transforming endoscopy into a first-line therapy. However, many sessions are often required, with variable success rates. Owing to these limitations, the off-label use of cardiac septal occluders (CSOs) has been reported.
We searched for articles related to CSOs in the MEDLINE, EMBASE, Cochrane Library, and LILACS databases and gray literature. The primary outcomes included technical success, clinical success, and safety of CSOs in GI fistula management.
A total of 25,574 records were identified, and 19 studies ultimately satisfied the inclusion criteria. Technical success was achieved in all cases. Of the 22 fistulas, 77.27% had successful closure, with a mean follow-up period of 32.02 weeks. The adverse event rate was 22.72%, with no associated mortality. Univariable and multivariable regression analyses showed no significant difference in the success of closure and adverse events in relation to several variables among the subgroups.
The use of CSOs appeared to be technically feasible, effective, and safe in the treatment of GI fistulas. The satisfactory results derived from this sparse literature suggest that it can be an option in the management of GI fistulas.

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Training in Bariatric and Metabolic Endoscopic Therapies
Pichamol Jirapinyo, Christopher C. Thompson
Clin Endosc 2018;51(5):430-438.   Published online September 30, 2018
DOI: https://doi.org/10.5946/ce.2018.148
AbstractAbstract PDFPubReaderePub
Bariatric endoscopy is an emerging subspecialty for gastroenterologists encompassing a broad array of procedures including primary endoscopic bariatric and metabolic therapies and the treatment of complications of bariatric surgery. In addition, comprehensive understanding of lifestyle intervention and pharmacotherapy are essential to successful outcomes. This review summarizes goals and steps of training for this emerging field.

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Endoscopic Ultrasound-Guided Pancreatobiliary Endoscopy in Surgically Altered Anatomy
Pichamol Jirapinyo, Linda S. Lee
Clin Endosc 2016;49(6):515-529.   Published online November 29, 2016
DOI: https://doi.org/10.5946/ce.2016.144
AbstractAbstract PDFPubReaderePub
Endoscopic retrograde cholangiopancreatography (ERCP) has become the mainstay of therapy for pancreatobiliary diseases. While ERCP is safe and highly effective in the general population, the procedure remains challenging or impossible in patients with surgically altered anatomy (SAA). Endoscopic ultrasound (EUS) allows transmural access to the bile or pancreatic duct (PD) prior to ductal drainage using ERCP-based techniques. Also known as endosonography-guided cholangiopancreatography (ESCP), the procedure provides multiple advantages over overtube-assisted enteroscopy ERCP or percutaneous or surgical approaches. However, the procedure should only be performed by endoscopists experienced in both EUS and ERCP and with the proper tools. In this review, various EUS-guided diagnostic and therapeutic drainage techniques in patients with SAA are examined. Detailed step-by-step procedural descriptions, technical tips, feasibility, and safety data are also discussed.

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