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Barkun AN

Daniel von Renteln, Mickael Bouin, Alan N Barkun
Colonoscopy and endoscopic removal of precancerous polyps play an important role in colorectal cancer (CRC) prevention. Improved endoscopes and quality standards have led to an increasing polyp and adenoma detection rate. Optimal polyp resection techniques and management strategies are key for an effective colonoscopy practice. Areas covered: Strategies for how to improve diminutive polyp (polyps up to 5mm in size) management are discussed because of their high prevalence. Systematic removal of diminutive polyps leads to increasing costs of colonoscopy practice, while the effect on colorectal cancer prevention might be negligible...
March 20, 2017: Expert Review of Gastroenterology & Hepatology
Sean Bennett, Alan Tinmouth, Daniel I McIsaac, Shane English, Paul C Hébert, Paul J Karanicolas, Alexis F Turgeon, Jeffrey Barkun, Timothy M Pawlik, Dean Fergusson, Guillaume Martel
OBJECTIVE: Create practice guidelines for the appropriate use of red blood cell transfusions in hepatectomy. BACKGROUND: Hepatectomy is associated with a high prevalence of transfusions. A transfusion can be life-saving, but can be associated with important adverse effects. Given the prevalence, the potential for benefit and harm, and the difficulty in conducting clinical trials, transfusion in hepatectomy is well-suited for a study of appropriateness. METHODS: Using the RAND/UCLA appropriateness method, an international, multidisciplinary expert panel in hepatobiliary surgery, anesthesia, transfusion medicine, and critical care rated a series of 468 perioperative scenarios for transfusion appropriateness...
March 10, 2017: Annals of Surgery
Jony van Hilst, Thijs de Rooij, Mohammed Abu Hilal, Horacio J Asbun, Jeffrey Barkun, Uggo Boggi, Olivier R Busch, Kevin C P Conlon, Marcel G Dijkgraaf, Ho-Seong Han, Paul D Hansen, Michael L Kendrick, Andre L Montagnini, Chinnusamy Palanivelu, Bård I Røsok, Shailesh V Shrikhande, Go Wakabayashi, Herbert J Zeh, Charles M Vollmer, David A Kooby, Marc G H Besselink
BACKGROUND: The introduction of minimally invasive pancreatic resection (MIPR) into surgical practice has been slow. The worldwide utilization of MIPR and attitude towards future perspectives of MIPR remains unknown. METHODS: An anonymous survey on MIPR was sent to the members of six international associations of Hepato-Pancreato-Biliary (HPB) surgery. RESULTS: The survey was completed by 435 surgeons from 50 countries, with each surgeon performing a median of 22 (IQR 12-40) pancreatic resections annually...
March 2017: HPB: the Official Journal of the International Hepato Pancreato Biliary Association
Sean Bennett, Laura K Baker, Guillaume Martel, Risa Shorr, Timothy M Pawlik, Alan Tinmouth, Daniel I McIsaac, Paul C Hébert, Paul J Karanicolas, Lauralyn McIntyre, Alexis F Turgeon, Jeffrey Barkun, Dean Fergusson
BACKGROUND: Liver resection is associated with a high proportion of red blood cell transfusions. There is a proposed association between perioperative transfusions and increased risk of complications and tumor recurrence. This study reviews the evidence of this association in the literature. METHODS: The Medline, EMBASE, and Cochrane databases were searched for clinical trials or observational studies of patients undergoing liver resection that compared patients who did and did not receive a perioperative red blood cell transfusion...
April 2017: HPB: the Official Journal of the International Hepato Pancreato Biliary Association
Majid A Almadi, Alan Barkun, Myriam Martel
OBJECTIVES: Self-expandable metal stents (SEMS) are thought to have an advantage over plastic stents in achieving biliary drainage. METHODS: We performed a systematic search of MEDLINE, EMBASE, Scopus, CENTRAL, and ISI Web of knowledge databases, from January 1980 to September 2015, for randomized-controlled trials (RCTs) comparing SEMS vs. plastic stents in the palliation of malignant biliary obstruction. Primary outcomes were durations of stent patency, patient survival, and 30-day mortality...
February 2017: American Journal of Gastroenterology
Aude Motulsky, Jenna Wong, Jean-Pierre Cordeau, Jorge Pomalaza, Jeffrey Barkun, Robyn Tamblyn
Objective: To describe the usage of a novel application (The FLOW) that allows mobile devices to be used for rounding and handoffs. Materials and Methods: The FLOW provides a view of patient data and the capacity to enter short notes via personal mobile devices. It was deployed using a "bring-your-own-device" model in 4 pilot units. Social network analysis (SNA) was applied to audit trails in order to visualize usage patterns. A questionnaire was used to describe user experience...
April 1, 2017: Journal of the American Medical Informatics Association: JAMIA
Jean-Luc Faillie, Oriana H Yu, Hui Yin, Dominique Hillaire-Buys, Alan Barkun, Laurent Azoulay
Importance: The use of dipeptidyl-peptidase-4 (DPP-4) inhibitors and glucagon-like peptide 1 (GLP-1) analogues-a group of drugs used in the management of type 2 diabetes mellitus-may be associated with an increased risk of bile duct and gallbladder disease. To date, no observational study has assessed this possible association. Objective: To determine whether the use of DPP-4 inhibitors and GLP-1 analogues is associated with an increased risk of incident bile duct and gallbladder disease in patients with type 2 diabetes...
October 1, 2016: JAMA Internal Medicine
Alastair Dorreen, Sarvee Moosavi, Myriam Martel, Alan N Barkun
Background. The safety of endoscopy after an acute coronary syndrome (ACS) is poorly characterized. We thus performed a systematic review assessing the safety of endoscopy following ACS. Methods. Searches in EMBASE, Medline, and Web of Science identified articles for inclusion. Data abstraction was completed by two independent reviewers. Results. Fourteen retrospective studies yielded 1178 patients (mean 71.3 years, 59.0% male) having suffered an ACS before endoscopy. Patients underwent 1188 endoscopies primarily to investigate suspected gastrointestinal bleeding (81...
2016: Canadian Journal of Gastroenterology & Hepatology
Julia McNabb-Baltar, Alastair Dorreen, Hisham Al Dhahab, Michael Fein, Xin Xiong, Mike O' Byrne, Imene Ait, Myriam Martel, Alan N Barkun
We examine the impact of key variables on the likelihood of inpatient poor bowel preparation for colonoscopy. Records of inpatients that underwent colonoscopy at our institution between January 2010 and December 2011 were retrospectively extracted. Univariable and multivariable logistic regression models were fitted to assess the effect of clinical variables on the odds of poor preparation. Tested predictors included age; gender; use of narcotics; heavy medication burden; comorbidities; history of previous abdominal surgery; neurological disorder; product used for bowel preparation, whether or not the bowel regimen was given as split or standard dose; and time of endoscopy...
2016: Canadian Journal of Gastroenterology & Hepatology
Frances Tse, Yuhong Yuan, Majidah Bukhari, Grigorios I Leontiadis, Paul Moayyedi, Alan Barkun
BACKGROUND: Difficult cannulation is a risk factor for post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP). It has been postulated that the pancreatic duct guidewire (PGW) technique may improve biliary cannulation success and reduce the risk of PEP in people with difficult cannulation. OBJECTIVES: To systematically review evidence from randomised controlled trials (RCTs) assessing the effectiveness and safety of the PGW technique compared to persistent conventional cannulation (CC) (contrast- or guidewire-assisted cannulation) or other advanced techniques in people with difficult biliary cannulation for the prevention of PEP...
May 16, 2016: Cochrane Database of Systematic Reviews
C P Pennell, A D Hirst, W B Campbell, A Sood, R A Agha, J S T Barkun, P McCulloch
BACKGROUND: Evaluation of new surgical procedures is a complex process challenged by evolution of technique, operator learning curves, the possibility of variable procedural quality, and strong treatment preferences among patients and clinicians. Preliminary studies that address these issues are needed to prepare for a successful randomized trial. The IDEAL (Idea, Development, Exploration, Assessment and Long-term follow-up) Framework and Recommendations provide an integrated step-by-step evaluation pathway that can help investigators achieve this...
April 2016: British Journal of Surgery
Viviane Adam, Mamatha Bhat, Myriam Martel, Eduardo da Silveira, Caroline Reinhold, Eric Valois, Jeffrey S Barkun, Alan N Barkun
BACKGROUND: The optimal management of patients with suspected biliary obstruction remains unclear, and includes the possible performance of magnetic resonance cholangiopancreatography (MRCP) and endoscopic retrograde cholangiopancreatography (ERCP). OBJECTIVES: To complete a cost analysis based on a medical effectiveness randomized trial comparing an ERCP-first approach with an MRCP-first approach in patients with suspected bile duct obstruction. METHODS: The management strategies were based on a medical effectiveness trial of 257 patients over a 12-month follow-up period...
September 2015: Value in Health: the Journal of the International Society for Pharmacoeconomics and Outcomes Research
Yen-I Chen, Alan N Barkun
Topical hemostatic agents and powders are an emerging modality in the endoscopic management of upper and lower gastrointestinal bleeding. This systematic review demonstrates the effectiveness and safety of these agents with special emphasis on TC-325 and Ankaferd Blood Stopper. The unique noncontact/nontraumatic application, ability to cover large areas of bleed, and ease of use make these hemostatic agents an attractive option in certain clinical situations, such as massive bleeding with poor visualization, salvage therapy, and diffuse bleeding from luminal malignancies...
July 2015: Gastrointestinal Endoscopy Clinics of North America
Majid A Almadi, Maida Sewitch, Alan N Barkun, Myriam Martel, Lawrence Joseph
BACKGROUND: Operator fatigue may negatively influence adenoma detection (AD) during screening colonoscopy. OBJECTIVE: To better characterize factors affecting AD, including the number of hours worked, and the number and type of procedures performed before an index screening colonoscopy. METHODS: A retrospective cohort study was conducted involving individuals undergoing a screening colonoscopy at a major tertiary care hospital in Montreal, Quebec...
August 2015: Canadian Journal of Gastroenterology & Hepatology
A L Smith, C Bascuñana, A Hall, A Salman, A Z Andrei, A Volenik, H Rothenmund, D Ferland, D Lamoussenery, A S Kamath, R Amre, D Caglar, Z H Gao, D G Haegert, Y Kanber, R P Michel, G Omeroglu-Altinel, J Asselah, N Bouganim, P Kavan, G Arena, J Barkun, P Chaudhury, S Gallinger, W D Foulkes, A Omeroglu, P Metrakos, G Zogopoulos
BACKGROUND: Enrolling patients in studies of pancreatic ductal adenocarcinoma (pdac) is challenging because of the high fatality of the disease. We hypothesized that a prospective clinic-based study with rapid ascertainment would result in high participation rates. Using that strategy, we established the Quebec Pancreas Cancer Study (qpcs) to investigate the genetics and causes of pdac and other periampullary tumours (pats) that are also rare and underrepresented in research studies. METHODS: Patients diagnosed with pdac or pat were introduced to the study at their initial clinical encounter, with a strategy to enrol participants within 2 weeks of diagnosis...
April 2015: Current Oncology
Mazen Hassanain, Eve Simoneau, Ahmad Madkhali, Nouf Al-Saati, Murad Aljiffry, Jean Tchervenkov, Jeffrey Barkun, Peter Metrakos
BACKGROUND: Currently, there is no universally accepted method to evaluate liver function post-orthotopic liver transplant (OLTx) and there are no early surrogate function markers to assess the impact of perioperative interventions in trial settings. MATERIAL AND METHODS: In total, 495 patients were included in the study. On multivariate analysis, PTLF score, defined as normal (score <4) or dysfunctional (score ≥ 4), was the only significant variable for determining significant complications (P=0...
2015: Annals of Transplantation: Quarterly of the Polish Transplantation Society
Vladimir Marquez Azalgara, Maida J Sewitch, Lawrence Joseph, Alan N Barkun
BACKGROUND: Little is known about minor adverse events (MAEs) following outpatient colonoscopies and associated health care resource utilization. OBJECTIVE: To estimate the rates of incident MAE at two, 14 and 30 days postcolonoscopy, and associated health care resource utilization. A secondary aim was to identify factors associated with cumulative 30-day MAE incidence. METHODS: A longitudinal cohort study was conducted among individuals undergoing an outpatient colonoscopy at the Montreal General Hospital (Montreal, Quebec)...
December 2014: Canadian Journal of Gastroenterology & Hepatology
Marc Bardou, Jean-Pierre Quenot, Alan Barkun
Bleeding from stress-related mucosal disease in critically ill patients remains an important clinical management issue. Although only a small proportion (1-6%) of patients admitted to an intensive care unit (ICU) will bleed, a substantial proportion exhibit clinical risk factors (mechanical ventilation for >48 h and a coagulopathy) that predict an increased risk of bleeding. Furthermore, upper gastrointestinal mucosal lesions can be found in 75-100% of patients in ICUs. Although uncommon, stress-ulcer bleeding is a severe complication with an estimated mortality of 40-50%, mostly from decompensating an underlying condition or multiorgan failure...
February 2015: Nature Reviews. Gastroenterology & Hepatology
Sinziana Dumitra, Stephanie M Wong, Sarkis Meterissian, Robin Featherstone, Jeffrey Barkun, Paola Fata
BACKGROUND: The operative dictation (OD) is the cornerstone of surgical communication, yet there appears to be a lack of formal education of this skill by training programs. We conducted a review of the literature to assess the teaching and quality of OD in surgical residency programs. STUDY DESIGN: Multiple databases were searched for studies pertaining to "OD," "surgical education," and "formal teaching." Of 50 the studies, 13 were retained and assigned to one or more of the following categories: (1) surveys of the surgical community evaluating current perceptions of formal OD education (n = 5), (2) studies assessing the quality of OD performed by residents (n = 5), and (3) educational interventions for improving OD skills (n = 4)...
March 2015: Journal of Surgical Education
Sara El Ouali, Alan Barkun, Myriam Martel, Davide Maggio
BACKGROUND: Peptic ulcer rebleeding (PUR) usually occurs within three days following endoscopic hemostasis. However, recent data have increasingly suggested delayed rebleeding. 
 OBJECTIVE: To better characterize the timing of PUR (Forrest Ia to IIb) following initially successful endoscopic hemostasis. 
 METHODS: An exhaustive literature search (1989 to 2013), with cross-referencing, was performed to identify pertinent randomized controlled trial (RCT) arms...
November 2014: Canadian Journal of Gastroenterology & Hepatology
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