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Todd H Baron

Publications and source records attributed to Todd H Baron.

At least 19 recordsLinked to original sources
PubMed2006

Endoscopic retrograde cholangiopancreatography-induced severe acute pancreatitis.

BACKGROUND/AIMS: There is scant information in the literature about the outcomes of endoscopic retrograde cholangiopancreatography (ERCP)-induced severe acute pancreatitis (ESAP). Compared to other causes, higher morbidity and mortality have been reported in ERCP-induced acute pancreatitis. We undertook this study to determine the differences between ESAP and SAP due to other causes (OSAP). METHODS: We retrospectively identified all cases of SAP admitted to our institution during the years 1992-2001. We reviewed the medical records of all SAP patients to obtain information on demographics, interventions, local and systemic complications and outcomes. RESULTS: We identified 207 patients with SAP, of whom 16 (7.7%) had ESAP and 191 OSAP. There was no difference between ESAP and OSAP with regard to demographics, clinical interventions, local and systemic complications and outcomes. Both groups had a similar mortality (25 vs. 18%). CONCLUSION: ESAP has a similar morbidity and mortality compared to OSAP.

Acute Disease↗
PubMed2006

Validation of a colonoscopy simulation model for skills assessment.

OBJECTIVE: The purpose is to provide initial validation of a novel simulation model's fidelity and ability to assess competence in colonoscopy skills. METHODS: In a prospective, cross-sectional design, each of 39 endoscopists (13 staff, 13 second year fellows, and 13 novices) performed a colonoscopy on a novel bovine simulation model. Staff endoscopists also completed a survey examining different aspects of the model's realism as compared to human colonoscopy. The groups' simulation performances were compared. Additionally, individual performances were correlated to patient-based performance data. RESULTS: Median model realism evaluation scores were favorable for nearly all parameters evaluated with mucosa appearance, endoscopic view, and paradoxical motion parameters receiving the highest scores. During simulation procedures, each group outperformed the less experienced groups in all parameters evaluated. Specifically, median cecal intubation times were: staff 226 s (IQR [interquartile range] 179-273), fellows 340 s (282-568), and novices 1,027 s (970-1,122) (P < 0.05). Median total procedure times on the model were: staff 468 s (416-501), fellows 527 s (459-824), and novices 1,350 s (1,318-1,428) (P < 0.05). Finally, individual cecal intubation times on the simulation model had a very high correlation to their respective patient-based times (r = 0.764). CONCLUSIONS: Overall, this model possesses a favorable degree of realism and is able to easily differentiate users based on their level of colonoscopy experience. More impressive, however, is the strong correlation between individual's simulated intubation times and actual patient-based colonoscopy data. In light of these findings, we speculate that this model has potential to be an effective tool for assessment of colonoscopic competence.

Animals↗
PubMed2006

A novel endoscopic approach to brachytherapy in the management of Hilar cholangiocarcinoma.

OBJECTIVES: Traditionally, biliary brachytherapy sources are placed percutaneously via transhepatic drains or endoscopically via nasobiliary tubes (NBT). Another ERCP is needed for stent replacement after NBT removal. The aim of this study was to determine the feasibility and safety of endoscopic transpapillary insertion of irradiation sources through 10-Fr stents. METHODS: Medical records of Mayo Clinic Rochester patients undergoing biliary brachytherapy for hilar cholangiocarcinoma (CCA) were reviewed. Patients were part of a treatment protocol with curative intent including external beam radiation therapy (4,500 cGy), radiation sensitization (5-FU), and low dose rate (LDR) brachytherapy (<3,000 cGy) followed by liver transplantation. The 10-Fr biliary stent placed across the malignant biliary stricture was directly cannulated using a radiopaque (192)Ir embedded ribbon within a 300-cm long, 5.1-Fr plastic sheath. After withdrawal of the endoscope, the external end of the brachytherapy catheter was rerouted transnasally and secured. Each patient was hospitalized in a shielded room up to 24 h after which the brachytherapy catheter was removed by hand. RESULTS: Between 1999 and 2004, 32 patients underwent biliary brachytherapy via endoscopically placed 10-Fr plastic stents (mean age 50.6 yr, 69% PSC, bilateral brachytherapy catheters 28.1%). The technical complication observed was immediate brachytherapy catheter displacement (7 of 32, 22%) managed by prompt brachytherapy catheter repositioning. CONCLUSION: LDR biliary brachytherapy administration via endoscopically placed biliary stents is technically feasible and appears reasonably safe in select patients with unresectable perihilar CCA. Unlike NBTs, stents can potentially be placed in bilateral ductal systems to accommodate dual brachytherapy catheters when indicated.

Bile Duct Neoplasms↗
PubMed2006

Insertion and removal of covered expandable metal stents for closure of complex biliary leaks.

The traditional endoscopic management of bile leaks involves placement of plastic endoprostheses. The success rate for closure of simple leaks (cystic duct, Luschka's duct) with this approach is high. We describe 3 patients with complex biliary leaks of the gallbladder bed that were successfully closed by using transpapillary placement of covered self-expandable biliary stents. The stents were endoscopically removed after closure of the leak. All 3 patients had previously undergone open subtotal cholecystectomy for severe acute cholecystitis when complete cholecystectomy could not be performed because of dense acute inflammation. In 2 patients the leaks had not responded to traditional plastic biliary stent placement. This novel approach deserves further evaluation.

Aged↗
PubMed2006

Endoscopic transmural drainage of pancreatic pseudocysts: results of a national and an international survey of ASGE members.

BACKGROUND: Pancreatic pseudocysts can be drained endoscopically via the transpapillary or the transmural routes. We sought to assess endoscopic methods of pseudocyst drainage. METHODS: A web-based survey was sent to American Society for Gastrointestinal Endoscopy (ASGE) members in the United States (U.S.) and internationally. RESULTS: Of the 3054 endoscopists to whom the survey was sent, 266 (8.7%) replied; 198 performed pseudocyst drainage (103 [52%] ASGE members from the United States and 95 [48%] international members). The median of the total number of drainages per physician was 15 (range 1-364). The transgastric route was the most commonly used drainage route (65%). Transmural entry was performed by using a needle-knife in 53% of transmural drainages that were not EUS-guided. The number of stents placed ranged from 1 to 5 and these remained in place for 2 to 30 weeks. CT scan was used before drainage by 95% of all respondents. EUS imaging was used before drainage by 72 of 103 (70%) US endoscopists compared with 56 of 95 (59%) international endoscopists (p = 0.1). EUS-guided drainage was used by 56% of US endoscopists compared with 43% international endoscopists (p = 0.06). CONCLUSIONS: The most common site of transmural entry for drainage of pancreatic pseudocysts appears to be the transgastric route. Although CT is the most commonly used predrainage imaging modality, EUS is used before and during transmural drainage of pseudocysts in both the U.S. and abroad, particularly in academic medical centers. Use of EUS before or during drainage does not appear to be significantly different among endoscopists in the United States and internationally.

Cholangiopancreatography, Endoscopic Retrograde↗
PubMed2006

Abdominal CT as a predictor of outcome before attempted direct percutaneous endoscopic jejunostomy.

BACKGROUND: Direct percutaneous endoscopic jejunostomy (DPEJ) placement succeeds in 72% to 86% of attempts. Failure is most often because of inadequate transillumination or gastroduodenal obstruction. Even in failed cases, patients are exposed to the risks of anesthesia, exploratory percutaneous needle punctures, and the cost burden of suboptimal resource utilization. Hence, a preprocedure predictor of outcome would be useful. OBJECTIVE: To evaluate whether review of clinically available abdominal CTs can predict the outcome of subsequent DPEJ attempts. DESIGN: Retrospectively conducted blinded review of abdominal CTs performed within 30 days before attempted DPEJ. Objective anatomic features potentially pertinent to DPEJ success were scored, and a prediction of the anticipated procedural outcome was made. SETTING: A large tertiary referral center. PATIENTS: A total of 115 patients who underwent attempted DPEJ and who also had an abdominal CT in the preceding 30 days. MAIN OUTCOME MEASUREMENTS: Reviewer's overall prediction of success, 3 objective anatomic measurements. RESULTS: For the overall prediction of success, a CT performed poorly, with a sensitivity of 60%, a specificity of 53%, a positive predictive value of 71%, and a negative predictive value of 40%. Mean abdominal-wall thickness was significantly greater in the failures than the successes (27 vs 21 mm, P = .02), and just 39% of the procedures in patients with an abdominal-wall thickness >3 cm were successful. LIMITATIONS: Retrospective. CONCLUSIONS: Failed DPEJ attempts were associated with greater patient abdominal-wall thickness, and this should be taken into consideration before attempted DPEJ. Otherwise, review of existing abdominal CTs appears to have limited utility in predicting DPEJ outcome.

Abdominal Wall↗