Amit Rastogi

Kansas City VA Medical Center, Kansas City, Missouri, United States

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Publications (206)1757.08 Total impact

  • Vijay Kanakadandi · Amit Rastogi ·

    Endoscopy 09/2015; 47(10):873-875. DOI:10.1055/s-0034-1393046 · 5.05 Impact Factor
  • Shreyas Saligram · Amit Rastogi ·
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    ABSTRACT: The recent advent of advanced imaging technologies has brought real time characterization of polyp histology to the forefront. This concept of optical diagnosis of diminutive polyp histology can bring about a huge paradigm shift in the management of these lesions. Instead of resecting and sending all the diminutive polyps to pathology, there is the potential to practice "resect and discard" for those predicted to be adenomas and "do not resect" strategy for the recto-sigmoid polyps predicted to be hyperplastic. However, one of the major steps before the clinical implementation of real-time histology can be a reality, will be training endoscopists with varying levels of experience in novel imaging technologies. The two major methods for training include didactic teaching and the computer based method. After the initial training, it is imperative that the endoscopists practice this skill during performance of routine colonoscopy to auto validate and assess their own competency. Both practice and reinforcement can help endoscopists become high performers in the characterization of polyp histology.
    Best practice & research. Clinical gastroenterology 09/2015; 29(4):651-62. DOI:10.1016/j.bpg.2015.06.001 · 3.48 Impact Factor
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    ABSTRACT: Prevalence of advanced histology in flat adenomas is uncertain. There are limited data on the prevalence of synchronous adenomas in patients with flat adenomas. The aims of this study are to determine whether the flat adenomas harbor advanced histology more than the polypoid adenomas and whether the presence of flat adenoma is an independent predictor of synchronous adenomas. Retrospective analysis of data from 3 prospective clinical trials conducted at 2 tertiary care referral centers that included patients undergoing screening or surveillance colonoscopy. The location, size and morphology of each polyp resected was documented and sent for histopathological examination in a unique specimen jar. A total of 2931 polyps were removed in 1340 patients. Of the 1911 (65.2%) adenomas, 293 (15.3%) were flat and 1618 (84.7%) were polypoid. Prevalence of advanced histology did not differ between flat and polypoid adenomas (1.4% vs 3.1%; P= 0.13). Multivariate analysis confirmed that the presence of at least 1 flat adenoma was a predictor for the presence of a large adenoma (P < 0.01; OR = 2.80; 95% CI, 1.86 - 4.22), and advanced adenoma (P < 0.01; OR = 2.70; 95% CI, 1.80 - 4.06) and ≥3 adenomas (P < 0.01; OR = 2.44; 95% CI, 1.66 - 3.59). Although the prevalence of advanced histology in flat adenomas is similar to polypoid adenomas, flat adenomas are associated with increased prevalence of synchronous large and advanced adenomas. Whether these results imply shorter surveillance intervals in patients with flat adenomas needs to be explored in future studies. Copyright © 2015 American Society for Gastrointestinal Endoscopy. Published by Elsevier Inc. All rights reserved.
    Gastrointestinal endoscopy 09/2015; DOI:10.1016/j.gie.2015.08.040 · 5.37 Impact Factor
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    ABSTRACT: Goals: To determine whether gastroenterologists would be willing to accept the "predict, resect, and discard" strategy for diminutive colorectal polyps and identify potential barriers to implementation in clinical practice. Background: The ASGE recently published a Preservation and Incorporation of Valuable Endoscopic Innovations (PIVI) document on managing diminutive colorectal polyps using the "predict, resect, and discard" strategy. However, there is no data on whether gastroenterologists would accept this paradigm shift. Study: We performed a random survey of gastroenterologists at a national meeting. Awareness of and willingness to adopt the "predict, resect, and discard" practice, reasons for not utilizing it, and whether a financial incentive would be persuasive in implementing the practice were assessed. Results: A total of 105 gastroenterologists were surveyed. Seventy-six (72%) were aware of the PIVI statement and 64 (61%) stated they would be willing to implement this in practice. Medical-legal concerns (85%) and lack of financial incentives (32%) were the 2 most commonly cited barriers to implementation. Greater than 50% of those resistant to performing the service would be willing do so if given a financial incentive, with ~50% of gastroenterologists who cited an appropriate incentive preferring >$75 to do so. Of these, private practice gastroenterologists and those who had financial interest in sending polyps to pathology were the most likely to request this amount. Conclusions: Approximately two-thirds of gastroenterologists are willing to adopt the "predict, resect, and discard" strategy for managing diminutive colon polyps. Medical-legal concerns and lack of financial incentives are the primary barriers to implementation. Copyright
    Journal of Clinical Gastroenterology 07/2015; DOI:10.1097/MCG.0000000000000382 · 3.50 Impact Factor
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    ABSTRACT: The American Society of Gastrointestinal Endoscopy (ASGE) published updated guidelines in 2009 to help endoscopists manage the treatment of their patients who have been prescribed antiplatelet therapy (APT). To assess the use of APT among endoscopists, and to identify factors guiding their use of APT while treating their patients. A survey questionnaire was distributed to endoscopists at two national meetings to assess their usage of APT while treating patients during the peri-endoscopic period. The survey was provided to 400 attendees of whom 239 (60 %) responded. Only 30 % of respondents followed the ASGE guidelines for treating their patients and 26 % percent of respondents withheld all APT before engaging in any patient procedure. Endoscopists' decisions appeared to be influenced by their own particular experiences rather than any specific APT usage guidelines (46 % vs 22 %; P < 0.05). As expected, more endoscopists (P < 0.05) continued APT for patients who underwent low risk procedures (90 %) than for patients who underwent high risk procedures (47 %). Approximately 50 % of the respondents did not perform high risk procedures for patients prescribed aspirin therapy. About one-fourth of endoscopists surveyed discontinued APT treatment of patients who underwent any endoscopic procedure, and one-half of them discontinued use of non-steroidal anti-inflammatory drug treatment of patients who underwent a high risk endoscopic procedure. Inappropriate withdrawal of APT medications may expose patients to unnecessary risks, and efforts to improve endoscopists' application of ASGE guidelines for the use of APT to treat patients during the peri-endoscopic period are warranted.
    06/2015; 3(3):E173-8. DOI:10.1055/s-0034-1390750
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    ABSTRACT: It has been postulated that the endoscopic ablation of Barrett's esophagus can lead to complete eradication of the disease. This study was undertaken to evaluate the efficacy of endoscopic eradication therapy for Barrett's esophagus and the rates of recurrence of intestinal metaplasia. As part of an initial randomized controlled trial, patients with nondysplastic or low grade dysplastic Barrett's esophagus underwent mucosal ablation. Following ablation, the patients had annual surveillance endoscopies. Recurrence was defined as the presence of intestinal metaplasia after initial complete eradication had been achieved. A total of 28 patients with Barrett's esophagus were followed for a mean of 6.4 years after ablation therapy. At baseline, the majority of the patients had nondysplastic Barrett's esophagus (79 %). Initial complete eradication of intestinal metaplasia was achieved at a mean of 4.1 months. During long-term follow-up, initial recurrence of intestinal metaplasia was seen in 14 of the 28 of patients (50 %) at a mean of 40 months, and further maintenance ablation therapy was applied. At the final follow-up, 36 % of the patients had complete eradication of intestinal metaplasia, 18 % of the patients had intestinal metaplasia, and 21 % had died of unrelated causes; invasive esophageal adenocarcinoma had developed in 1 patient. The long-term results of this study demonstrate a recurrence rate of 50 % after complete eradication of Barrett's esophagus with endoscopic eradication therapy. In addition, re-recurrence (in 36 %), even after further maintenance endoscopic eradication therapy, and deaths unrelated to the disease (21 %) occurred. Complete remission of Barrett's esophagus appears to be a difficult goal to achieve. These results call into question the role of ablation in patients with low risk Barrett's esophagus.
    05/2015; 3(3). DOI:10.1055/s-0034-1391669

  • Gastrointestinal Endoscopy 05/2015; 81(5):AB532-AB533. DOI:10.1016/j.gie.2015.03.1809 · 5.37 Impact Factor

  • Gastrointestinal Endoscopy 05/2015; 81(5):AB270. DOI:10.1016/j.gie.2015.03.1372 · 5.37 Impact Factor

  • Gastrointestinal Endoscopy 05/2015; 81(5):AB328-AB329. DOI:10.1016/j.gie.2015.03.1457 · 5.37 Impact Factor

  • Gastrointestinal Endoscopy 05/2015; 81(5):AB325. DOI:10.1016/j.gie.2015.03.1449 · 5.37 Impact Factor

  • Gastrointestinal Endoscopy 05/2015; 81(5):AB275. DOI:10.1016/j.gie.2015.03.1384 · 5.37 Impact Factor
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    ABSTRACT: Background & aims: Narrow-band imaging (NBI) allows real-time histologic classification of colorectal polyps. We investigated whether eendoscopists without prior training in NBI can achieve the thresholds recommended by the American Society for Gastrointestinal Endoscopy: for diminutive colorectal polyps characterized with high-confidence, a ≥ 90% negative predictive value (NPV) for adenomas in the rectosigmoid and a ≥ 90% agreement in surveillance intervals. Methods: Twenty-six endoscopists, from two tertiary care centers, underwent standardized training in NBI interpretation. Endoscopists made real-time predictions of diminutive colorectal polyp histology and surveillance interval predictions based on NBI. Their performance was evaluated by comparing predicted with actual findings from histologic analysis. Multi-level logistic regression was used to assess predictors of performance. Cumulative summation (Cusum) analysis was used to characterize learning curves. Results: The endoscopists performed 1,451 colonoscopies and made 3,012 diminutive polyp predictions (74.3% high-confidence) using NBI. They made 898 immediate post-procedure surveillance interval predictions. An additional 505 surveillance intervals were determined with histology input. The overall NPV for high-confidence characterizations in the rectosigmoid was 94.7% (95% confidence interval [CI] 92.6%-96.8%) and the surveillance interval agreement was 91.2% (95% CI, 89.7%-92.7%). Overall, 97.0% of surveillance interval predictions would have brought patients back on time or early. High-confidence characterization was the strongest predictor of accuracy (odds ratio, 3.42; 95% CI, 2.72-4.29, p<0.001). Performance improved over time, however-according to Cusum analysis, only 7 participants (26.9%) identified adenomas with sufficient sensitivity such that further auditing is not required. Conclusions: With standardized training, gastroenterologists without prior expertise in NBI were able to meet the NPV and surveillance interval thresholds set forth by the ASGE. The majority of disagreement in surveillance interval brought patients back early. Performance improves with time, but most endoscopists will require ongoing auditing of performance.
    Gastrointestinal Endoscopy 05/2015; 81(5):AB149. DOI:10.1016/j.gie.2015.03.1239 · 5.37 Impact Factor
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    ABSTRACT: Background and study aim: Data are limited on the natural history of patients with Barrett's esophagus with a diagnosis of "indefinite for dysplasia" (IND). The aims of this study were to: (i) determine rates of progression to high grade dysplasia (HGD) or esophageal adenocarcinoma, and compare these with rates for low grade dysplasia (LGD); and (ii) determine the proportion of patients whose histological IND diagnosis changed on follow-up endoscopy. Patients and methods: Demographic, endoscopic, and histologic information of patients with diagnoses of IND and LGD and at least 12 months of follow-up were extracted from the database of a multicenter Barrett's esophagus study. Rates and times for progression to HGD and esophageal adenocarcinoma and regression to nondysplastic epithelium were calculated. Proportions of diagnoses upgraded to HGD/esophageal adenocarcinoma or downgraded to nondysplastic epithelium at first follow-up endoscopy were evaluated. Results: Amongst 2264 patients, 83 with a diagnosis of IND (mean age 60 years, 95 % men, 95 % white; mean follow-up 5.6 years) and 79 with diagnosis of LGD were identified. In the IND group, annual incidences of esophageal adenocarcinoma and HGD were 0.21 % and 0.64 %, respectively, representing a combined incidence of 0.8 %. Mean time to progression was 4.72 years. Within the IND group 55 % patients showed regression to nondysplastic epithelium at first follow-up endoscopy and the overall regression rate was 80 %. Corresponding rates in LGD patients were similar. Conclusions: Lesions diagnosed as IND and LGD show similar biological behavior and can be treated as a single category with respect to surveillance and follow-up. © Georg Thieme Verlag KG Stuttgart · New York.
    Endoscopy 04/2015; 47(8). DOI:10.1055/s-0034-1391966 · 5.05 Impact Factor
  • Shreyas Saligram · Amit Rastogi ·
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    ABSTRACT: Although removal of adenomatous polyps has been shown to decrease the risk of colon cancer, distal hyperplastic polyps are thought to not have malignant potential. Most polyps detected during colonoscopy are diminutive (≤5 mm) and rarely harbor advanced histology, such as high-grade dysplasia or cancer. Therefore, predicting histology in real-time during colonoscopy can potentially decrease the enormous expenditure that ensues from universal histopathologic evaluation of polyps, and several novel imaging technologies have been developed and tested over the past decade for this purpose. Of these different technologies, electronic chromoendoscopy seems to strike a fair balance between accuracy, feasibility, and cost. Published by Elsevier Inc.
    Gastrointestinal endoscopy clinics of North America 04/2015; 25(2):261-286. DOI:10.1016/j.giec.2014.11.009

  • Gastroenterology 04/2015; 148(4):S-939-S-940. DOI:10.1016/S0016-5085(15)33205-4 · 16.72 Impact Factor
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    ABSTRACT: Long-term population-based data comparing endoscopic therapy (ET) and surgery for management of malignant colorectal polyps (MCPs) are limited. To compare colorectal cancer (CRC)-specific survival with ET and surgery. Population-based study. Patients with stage 0 and stage 1 MCPs were identified from the Surveillance Epidemiology and End Results (SEER) database (1998-2009). Demographic characteristics, tumor size, location, treatment modality, and survival were compared. Propensity-score matching and Cox proportional hazards regression models were used to evaluate the association between treatment and CRC-specific survival. ET and surgery. Mid-term (2.5 years) and long-term (5 years) CRC-free survival rates and independent predictors of CRC-specific mortality. Of 10,403 patients with MCPs, 2688 (26%) underwent ET and 7715 (74%) underwent surgery. Patients undergoing ET were more likely to be older white men with stage 0 disease. Surgical patients had more right-sided lesions, larger MCPs, and stage 1 disease. There was no difference in the 2.5-year and 5-year CRC-free survival rates between the 2 groups in stage 0 disease. Surgical resection led to higher 2.5-year (97.8% vs 93.2%; P < .001) and 5-year (96.6% vs 89.8%; P < .001) CRC-free survival in stage 1 disease. These results were confirmed by propensity-score matching. ET was a significant predictor for CRC-specific mortality in stage 1 disease (hazard ratio 2.40; 95% confidence interval, 1.75-3.29; P < .001). Comorbidity index not available, selection bias. ET and surgery had comparable mid- and long-term CRC-free survival rates in stage 0 disease. Surgical resection is the recommended treatment modality for MCPs with submucosal invasion. Copyright © 2015 American Society for Gastrointestinal Endoscopy. Published by Elsevier Inc. All rights reserved.
    Gastrointestinal Endoscopy 03/2015; 81(3). DOI:10.1016/j.gie.2014.11.049 · 5.37 Impact Factor
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    ABSTRACT: Background Colonoscopy offers limited protection against right-sided colon cancer, a significant proportion of which arise from the serrated pathway of carcinogenesis. The aim of this study was to compare cap-assisted colonoscopy and standard high-definition white light colonoscopy regarding serrated polyps¿ detection.Methods Post hoc analysis was performed of a previously conducted randomized controlled trial comparing standard and cap-assisted colonoscopy for adenoma detection. Randomization was stratified based on the indication of colonoscopy and all procedures were performed by three experienced endoscopists. Following cecal intubation, the colonic mucosa was carefully inspected during withdrawal of colonoscope and all polyps detected were documented for their size, location, morphology and then removed and sent for histopathology. Detection rates of significant serrated polyps between both arms were compared using the Fisher¿s exact test and Wilcoxon Rank Sum test.Results427 patients were enrolled (7 exclusions, 210 completed study in each arm, mean age of 61 years, 95% male, 75% Caucasian, 67% screening colonoscopies). There were no significant differences in baseline characteristics between both groups. Cap-assisted colonoscopy detected a significantly higher proportion of subjects with significant serrated polyps as well as a higher total number of significant serrated polyps compared to standard colonoscopy (12.8% vs. 6.6%, p =0.047 and 40 vs. 20,p¿=¿0.03 respectively).Conclusions In this post-hoc analysis, Cap-assisted colonoscopy is a safe technique that offers a higher detection rate of significant serrated polyps when compared to standard colonoscopy. If confirmed in future trials, this simple technique has the potential to improve protection against interval colon cancers.
    BMC Gastroenterology 02/2015; 15(1):11. DOI:10.1186/s12876-015-0234-1 · 2.37 Impact Factor

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    ABSTRACT: Patient outcomes for esophageal adenocarcinoma (EAC) have not improved despite huge advances in endoscopic therapy because cancers are being diagnosed late. Barrett's esophagus (BE) is the primary precursor lesion for EAC, and thus the non-endoscopic molecular diagnosis of BE can be an important approach to improve EAC outcomes if robust biomarkers for timely diagnosis are identified. MicroRNAs (miRNAs) are tissue-specific novel biomarkers that regulate gene expression and may satisfy this requirement. Patients with gastroesophageal reflux disease (GERD) and BE were selected from an ongoing tissue and serum repository. BE was defined by the presence of intestinal metaplasia. Previously published miRNA sequencing profiles of GERD and BE patients allowed us to select three miRNAs, miR-192-5p, -215-5p, and -194-5p, for further testing in a discovery cohort and an independent validation cohort. Receiver operating curves were generated to calculate the diagnostic accuracy of these miRNAs for BE diagnosis. To test specificity, the miRNA signature was compared with those of the gastric cardia epithelium and the non-intestinal-type columnar epithelium (another definition of BE). In addition, to gain insights into BE origin (intestinal vs non-intestinal), global BE miRNA profiles were compared with the published miRNA profiles of other columnar epithelia in the gastrointestinal tract, that is, normal stomach and small and large intestine. The discovery cohort included 67 white male patients (40 with GERD and 27 with BE). The validation cohort included 28 patients (19 with GERD and 11 with BE). In the discovery cohort, the sensitivity, specificity and area under the curve (AUC) of the three mRNAs for BE diagnosis were 92-100%, 94-95%, and 0.96-0.97, respectively. During validation, the sensitivity and specificity of miRNAs for BE diagnosis were as follows: miR-192-5p, 92% and 94%, AUC 0.94 (0.80-0.99, P=0.0004); miR-215-5p, 100% and 94%, AUC 0.98 (0.84-1, P=0.0004); and miR-194-5p, 91% and 94%, AUC 0.96 (0.80-0.99, P=0.0001), respectively. The tested miRNAs identified all BE patients in both the discovery and the validation cohorts. When compared with non intestinal-type columnar and gastric cardia epithelia, the miRNA signature was specific to the intestinal-type columnar epithelium. Comparisons of BE miRNA sequencing data to published data sets for the normal stomach, small intestine and large intestine confirmed that two of the three miRNAs (miR-215-5p and -194-5p) were specific to the intestinal-type epithelium. MicroRNAs are highly accurate for detecting intestinal-type BE epithelia and should be tested further for the non-endoscopic molecular diagnosis of BE.
    Clinical and Translational Gastroenterology 12/2014; 5(12):e65. DOI:10.1038/ctg.2014.17
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    ABSTRACT: Objectives The objective was to estimate emergency department (ED) visits for Clostridium difficile infection in the United States for the years 2006 through 2010.Methods Estimates of ED visits for C. difficile infection were calculated in patients 18 years and older using the Nationwide Emergency Department Sample.ResultsDuring the calendar years 2006 through 2010, there were an estimated total of 491,406,018 ED visits. Of these, 462,160 ED visits were associated with a primary International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis of C. difficile. The C. difficile infection ED visit rate (visits/100,000 census population) increased from 34.1 in 2006 to 42.3 in 2010, an increase of 24% (p < 0.01). There was also a significant overall increased trend in the number of ED visits for C. difficile from 2006 through 2010 (p < 0.01). The highest ED visit rate for C. difficile was observed for patients 65 years and older (163.18 per 100,000), while the lowest visit rate was for patients aged 18 to 24 years (5.10 per 100,000). The greatest increase in C. difficile infection visits occurred in the age group 18 to 24 years.Conclusions These results indicate an increased trend of ED visits for C. difficile in the period 2006 through 2010 with an overall population-adjusted increase of 24%. This represents important complementary data to previous studies reporting an increase in the rate of C. difficile infections in the U.S. hospitalized population.
    Academic Emergency Medicine 12/2014; 22(1). DOI:10.1111/acem.12552 · 2.01 Impact Factor

Publication Stats

2k Citations
1,757.08 Total Impact Points


  • 2009-2015
    • Kansas City VA Medical Center
      Kansas City, Missouri, United States
    • University of North Carolina at Chapel Hill
      • Division of Gastroenterology and Hepatology
      North Carolina, United States
  • 2006-2015
    • University of Kansas
      • • School of Medicine
      • • Division of Gastroenterology, Hepatology and Motility
      Lawrence, Kansas, United States
  • 2005-2015
    • Kansas City University of Medicine and Biosciences
      • Department of Pathology
      Kansas City, Missouri, United States
  • 2014
    • United States Department of Veterans Affairs
      Бедфорд, Massachusetts, United States
  • 2013
    • University of Colorado
      • Division of Gastroenterology and Hepatology
      Denver, Colorado, United States
    • Oregon Health and Science University
      • Division of Gastroenterology & Hepatology
      Portland, Oregon, United States
  • 2008-2013
    • University of Missouri - Kansas City
      • Veterans Affairs Medical Center
      Kansas City, Missouri, United States
  • 2012
    • University Medical Center Utrecht
      • Department of Gastroenterology and Hepatology
      Utrecht, Utrecht, Netherlands
  • 2011
    • Cedars-Sinai Medical Center
      • Cedars Sinai Medical Center
      Los Ángeles, California, United States