Isaac Raijman
Baylor College of Medicine, Internal Medicine, Faculty Member
- Therapeutic endoscopist and gastroenterologist with an interest in pancreatobiliary procedures, interventional EUS. C... moreTherapeutic endoscopist and gastroenterologist with an interest in pancreatobiliary procedures, interventional EUS. Clinical appointments at Baylor College of Medicine and University of Texas in Houston. Member of Texas Digestive Disease Consultants.edit
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Miniature endoscopes that can be introduced into the bile duct through the duodenoscope during endoscopic retrograde cholangiopancreatography were developed to allow nonsurgical management of difficult biliary stones. The direct... more
Miniature endoscopes that can be introduced into the bile duct through the duodenoscope during endoscopic retrograde cholangiopancreatography were developed to allow nonsurgical management of difficult biliary stones. The direct visualization enabled by these cholangioscopes of the biliary epithelium provides additional data in the assessment of biliary strictures. Cholangioscopy allows assessment of the biliary lumen, biliary epithelium, targeted tissue acquisition, targeted therapy, and wire guidance.
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Metal stents are frequently used for palliation of malignant dysphagia. Recently, a new stent design, the partially covered Wallflex stent (Boston Scientific, Natick, Mass), has been introduced. To determine clinical effectiveness and... more
Metal stents are frequently used for palliation of malignant dysphagia. Recently, a new stent design, the partially covered Wallflex stent (Boston Scientific, Natick, Mass), has been introduced. To determine clinical effectiveness and safety of the esophageal Wallflex stent for the palliation of dysphagia. A prospective follow-up study evaluating a new stent design. Three tertiary-care referral centers. This study involved 37 patients with cancer of the esophagus or gastric cardia. Stent placement. Data were collected regarding technical and clinical outcome, complications, recurrent dysphagia, and survival. A total of 37 patients (median age, 67 years; range, 48-84 years; 22 men [59%]) had a Wallflex stent placed. Stent placement was technically successful in all but 1 patient. Dysphagia improved from a median dysphagia score of 3 (ability to swallow liquids only) to 1 (ability to eat some solid foods) 4 weeks after stent placement. Major complications occurred in 3 patients (8%; pneumonia in 1, severe pain in 2), and 1 patient (3%) died from a complication (pneumonia). Minor complications included mild retrosternal pain in 10 patients (27%) and regurgitation in 7 patients (19%). In total, 8 patients (22%) developed recurrent dysphagia because of stent migration (n = 2 [6%]), food impaction (n = 2 [6%]), or tissue ingrowth or overgrowth (n = 4 [10%]). Nonrandomized study design. Placement of a partially covered Wallflex stent is safe and effective for the palliation of malignant dysphagia, with migration and tissue in- and overgrowth rates comparable to those of similarly designed stents. Retrosternal pain may occur more often with this stent than with other stent designs.
Research Interests: Palliative Care, Cancer, Dysphagia, Medicine, Humans, and 15 moreFemale, Pneumonia, Male, Recurrence, Clinical Sciences, Aged, Middle Aged, Gastrointestinal Endoscopy, Esophagus, prosthesis Design, FOREIGN BODY MIGRATION, Equipment Failure Analysis, Chest Pain, Esophageal Stenosis, and Deglutition disorders
Mucinous ductal ectasia (MDE) is an uncommon disease characterized by a patulous duodenal papilla extruding mucus, and a pancreatogram showing dilation with amorphous filling defects, communication of the mass with the pancreatic duct,... more
Mucinous ductal ectasia (MDE) is an uncommon disease characterized by a patulous duodenal papilla extruding mucus, and a pancreatogram showing dilation with amorphous filling defects, communication of the mass with the pancreatic duct, the mass usually being located in the head of the pancreas. We have recently treated three men and three women, mean age 66 years, with MDE. All had abdominal pain, while 33% had the clinical picture of pancreatic insufficiency. Three patients had recurrent pancreatitis, and three had biliary obstruction. Endoscopic retrograde cholangiopancreatography and imaging studies showed a patulous papilla draining mucus in six, pancreatic duct dilation in six, filling defects in six, and communication between the cystic mass and the pancreatic duct in five. A distinct finding not previously reported was a separate pancreatic and biliary orifice in two. Three patients had cancer, two cases being metastatic and one being found at surgery (not suspected preoperatively). Therapy included endoscopic biliary drainage in two, surgery in three, while one refused surgery. Of the operated patients, two underwent resection, one of whom had benign disease and the other cancer; both patients are doing well 14 and 32 months after surgery, respectively. One patient underwent pancreatojejunostomy without symptomatic relief, and developed cholangitis 18 months after surgery that was successfully treated with endoscopic drainage. The other two patients treated with biliary drainage died one and 13 months later, respectively. We conclude that MDE has characteristic pancreatographic and endoscopic findings, and that it is commonly associated with malignant degeneration. Surgical resection is the treatment of choice, since MDE is premalignant, and surgery may be curative when the malignancy is resectable.
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Research Interests: Surgery, Epidemiology, Gastroenterology, Fracture, Medicine, and 15 moreComplication, Humans, Incidence, Clinical Sciences, Spectrum, Perforation, Lithotripsy, Bile Duct, Stent, Renal Calculi, Endoscopic Retrograde Cholangiopancreatography, The American, Choledocholithiasis, Equipment failure, and Common bile duct
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IntroductionSensitivities of various sampling methods to detect malignant biliary strictures remain suboptimal. Irrigation during digital single operator cholangioscopy (dSOC) is done routinely for visualization of the duct. The aim of... more
IntroductionSensitivities of various sampling methods to detect malignant biliary strictures remain suboptimal. Irrigation during digital single operator cholangioscopy (dSOC) is done routinely for visualization of the duct. The aim of this study was to evaluate improvement of the sensitivity for detecting malignant biliary strictures when adding aspiration fluid cytology (AFC) from the irrigated fluid during cholangioscopy to cholangioscopic biopsy (CBx).MethodsWe conducted a retrospective analysis of patients at a tertiary medical center who underwent CBx for evaluation of their biliary strictures. We included patients who had aspiration of fluid from the bile duct after CBx and were sent for cytology from January 2017 to October 2017. Diagnosis was made on the basis of final pathology or follow‐up over 9 months.ResultsFifty‐six patients had CBx obtained, out of which 35 patients had AFC in conjunction. Twenty‐two (62%) patients were male and the average age was 65 years. Considering atypical cells as benign, the sensitivity, specificity, positive and negative predictive values (PPV, NPV) for CBx were 62.5%, 100%, 100%, and 76% respectively. When CBx combined with AFC, the above statistics went up to 81.25%, 100%, 100%, and 86.36% respectively. When atypical cells were considered malignant, the sensitivity, specificity, PPV and NPV for CBx were 81.25%, 84.21%, 81.25%, 84.21% and increased to 93.75%, 78.94%, 78.94%, and 93.75% respectively after adding AFC results.ConclusionFor patients with biliary stricture, addition of AFC dSOC guided biopsies, significantly improves the sensitivity for detecting malignancy.
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Malnutrition is common and often undiagnosed in affected patients, especially those in the hospital, and is associated with impaired organ function, increased morbidity, and prolongation of hospital stay. It should be recognized and... more
Malnutrition is common and often undiagnosed in affected patients, especially those in the hospital, and is associated with impaired organ function, increased morbidity, and prolongation of hospital stay. It should be recognized and treated appropriately, because artificial nutritional support in malnourished patients leads to improvement in nutritional status and clinical outcome. There are multiple methods to provide nutrition, some by simply keeping the esophageal lumen patent, others by providing additional or all nutrients, including enteral and parenteral routes. The enteral route is preferred due to patient acceptance, lesser expense, and lower risk of complications. The addition of specific nutrients over standard diets may add benefit. Preoperative nutrition may reduce the risk of postoperative complications. Lastly, in the terminally ill patient, minimal intervention may be all that is needed to achieve the patient's comfort, perhaps the most important goal.
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No abstract is available. To read the body of this article, please view the Full Text online. ... © 2008 American Society for Gastrointestinal Endoscopy. Published by Elsevier Inc. All rights reserved. ... Visit SciVerse ScienceDirect to... more
No abstract is available. To read the body of this article, please view the Full Text online. ... © 2008 American Society for Gastrointestinal Endoscopy. Published by Elsevier Inc. All rights reserved. ... Visit SciVerse ScienceDirect to see if you have access via your institution.
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Video capsule endoscopy is now a first-line tool in evaluating and diagnosing gastrointestinal bleeding, inflammatory bowel disease, and small bowel neoplasms. Capsule nonpassage or retention is an uncommon but clinically significant... more
Video capsule endoscopy is now a first-line tool in evaluating and diagnosing gastrointestinal bleeding, inflammatory bowel disease, and small bowel neoplasms. Capsule nonpassage or retention is an uncommon but clinically significant occurrence. How to best retrieve these retained capsules is currently being debated. We report a laparoscopic approach for the retrieval of a retained capsule in the terminal ileum.
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The rabbit cecum is a moderately tight epithelium with amiloride-resistant but phenamil-sensitive electrogenic Na absorption. We performed flux and electrical studies under short-circuit conditions in vitro to further characterize the... more
The rabbit cecum is a moderately tight epithelium with amiloride-resistant but phenamil-sensitive electrogenic Na absorption. We performed flux and electrical studies under short-circuit conditions in vitro to further characterize the mechanisms of ion transport in cecum in normal and animals pretreated with methylprednisolone (MP) and deoxycorticosterone acetate (DOCA). MP treatment increased Na absorption and decreased tissue conductance. In contrast, DOCA increased Isc but did not significantly alter Na or Cl fluxes. Amiloride analogs with primary specificity for Na channel and Na/H exchanger both inhibited Isc and Na absorption. Ethacrynic acid, but not bumetanide, inhibited Isc. Nystatin and amphotericin B increased Isc. We conclude that: (1) Steroids have a differential effect on cecal ion transport; methylprednisolone increases Na absorption, but DOCA does not. (2) The response to amiloride analogs is different from other electrogenic transport systems, suggesting a distinct mechanism of Na transport in cecum. (3) The effect of ethacrynic acid was unexpected, suggesting an inhibitory response on an alternate transport system. (4) The effects of polyene antibiotics are similar to those found in other tight epithelia. Electrogenic Na absorption in rabbit cecum represents a distinct transport system, significantly different from Na absorptive mechanisms in other segments of the gut.
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... 年，卷(期) ：, 2005, 61. 分类号 ：, 关键词 ：, 正文语种 ：, 基金项目 ：, 被引用次数 ：, 1. 引证文献 (1 条 ) RSS. Atif Iqbal.Vanessa Salinas.Charles J Filipi Endoscopic therapies of gastroesophageal reflux disease [期刊论文] -世界胃肠病学杂志（英文版）2006(17). >> 更多 ... 相似文献.... more
... 年，卷(期) ：, 2005, 61. 分类号 ：, 关键词 ：, 正文语种 ：, 基金项目 ：, 被引用次数 ：, 1. 引证文献 (1 条 ) RSS. Atif Iqbal.Vanessa Salinas.Charles J Filipi Endoscopic therapies of gastroesophageal reflux disease [期刊论文] -世界胃肠病学杂志（英文版）2006(17). >> 更多 ... 相似文献. 相关博文 ...
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Background: Because treatment of advanced pancreatic cancer is often unsuccessful, early detection is important. Codon 12 c-Ki-ras mutations have been found in 80-90% of pancreatic cancer cases and are a potential early marker for... more
Background: Because treatment of advanced pancreatic cancer is often unsuccessful, early detection is important. Codon 12 c-Ki-ras mutations have been found in 80-90% of pancreatic cancer cases and are a potential early marker for pancreatic cancer, but obtaining tissue or fluid for analysis can be difficult. We therefore evaluated whether mutant c-Ki-ras could be detected in bile samples obtained from pancreatic cancer patients. Methods: DNA was isolated from bile specimens obtained from 20 patients with pancreatic cancer. The mutant-enriched PCR technique (ME-PCR) was used to amplify and detect point mutations at codon 12 of the c-Ki-ras oncogene. Results: In 17 cases sufficient DNA for amplification was obtained; 14 had mutant c-Ki-ras alleles. Cytological evaluation of the bile was performed in 11 of these cases, but was positive in only two cases; both were positive for codon 12 c-Ki-ras mutations. Of the 9 cytologically negative biliary specimens, ME-PCR was positive in six. Conclusions: Codon 12 c-Ki-ras mutations can be successfully identified in PCR-amplified DNA from bile samples obtained from patients with advanced pancreatic cancer. This technique may supplement cytologic techniques for diagnosing pancreatic cancer and may be capable of identifying individuals at risk for this disease.
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BACKGROUND AND AIMS EUS-directed transgastric ERCP (the EDGE procedure) is a simplified method of performing ERCP in Roux-en-Y gastric bypass patients. [1] The EDGE procedure involves placement of a lumen-apposing metal stent (LAMS) into... more
BACKGROUND AND AIMS EUS-directed transgastric ERCP (the EDGE procedure) is a simplified method of performing ERCP in Roux-en-Y gastric bypass patients. [1] The EDGE procedure involves placement of a lumen-apposing metal stent (LAMS) into the excluded stomach to serve as a conduit for passage of the duodenoscope for pancreatobiliary intervention. Originally a multistep process, urgent indications for ERCP have led to the development of single-session EDGE (SS-EDGE) with LAMS placement and ERCP performed in the same session. [2-3] The goal of this study was to identify predictive factors of intraprocedural LAMS migration in SS-EDGE. METHODS We conducted a multicenter retrospective review that included 9 tertiary medical centers across the United States. Data were collected and analyzed from 128 SS-EDGE procedures. The primary outcome was intraprocedural LAMS migration. Secondary outcomes included other procedural adverse events such as bleeding and perforation. RESULTS In total, 11 LAMS migrations were observed in 128 procedures (8.6%). Univariate analysis of clinically relevant variables was performed, as was a binary logistic regression analysis of stent diameter and stent dilation. This revealed that use of a smaller (15 mm) diameter LAMS was an independent predictor of intraprocedural stent migration (OR, 5.36; 95% CI,1.29-22.24; p=0.021). Adverse events included 3 patients who required surgery and 2 who experienced intraprocedural bleeding. CONCLUSIONS Use of larger-diameter LAMS is a predictive factor for a nonmigrated stent and improved procedural success in SS-EDGE. Although larger patient cohorts are needed to adequately assess, performance of LAMS dilation and fixation may also decrease risk of intraprocedural LAMS migration and improve procedural success.