Patrick Yachimski

Vanderbilt University, Нашвилл, Michigan, United States

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Publications (59)357.93 Total impact

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    ABSTRACT: OBJECTIVES: Symptom eradication in patients with Barrett’s esophagus (BE) does not guarantee control of acid or duodenogastroesophageal reflux (DGER). Continued reflux of acid and/or DGER may increase risk of neoplastic progression and may decrease the likelihood of columnar mucosa eradication after ablative therapy. To date, no study has addressed whether both complete acid and DGER control is possible in patients with BE. This prospective study was designed to assess the effect of escalating-dose proton pump inhibitor (PPI) therapy on esophageal acid and DGER.
    The American Journal of Gastroenterology 06/2015; 110(8). DOI:10.1038/ajg.2015.161 · 10.76 Impact Factor
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    Lisa Cassani · James C Slaughter · Patrick Yachimski ·
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    ABSTRACT: Objectives Multiple endoscopic sessions may be necessary for treatment and surveillance of Barrett’s esophagus (BE)-associated neoplasia. Adherence to an endoscopic therapeutic regimen is important for longitudinal management of BE. The objective of this study was to identify the factors associated with adherence to therapy for BE-associated neoplasia.
    05/2015; DOI:10.1177/2050640615585469

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    Ashley Canipe · James Slaughter · Patrick Yachimski ·
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    ABSTRACT: Endoscopic mucosal resection (EMR) plays an important role in the staging of Barrett's esophagus (BE) and the evaluation of high grade dysplasia (HGD). The study aim is to assess the interobserver agreement among gastroenterologists expert in BE endotherapy, gastroenterologists without specified expertise in BE endotherapy, and gastroenterology trainees in recommending EMR vs ablation for BE HGD lesions, and to assess the effect of a one-time educational intervention on the interobserver agreement among non-experts and trainees. An electronic survey containing 30 still endoscopic images of BE HGD was sent to three groups of respondents: experts, non-experts, and trainees. Respondents were asked to select "Endoscopic Mucosal Resection" or "Ablation" as the most appropriate next step in management. Non-experts and trainees were then invited to repeat the survey following an educational intervention. The main outcome measure was interobserver agreement measured by Fleiss' Kappa statistic and percent agreement. In selecting between EMR and ablation, on the pre-intervention survey there was the highest amount of agreement among experts (kappa = 0.437), followed by agreement among trainees (kappa = 0.281), and non-experts (kappa = 0.107). Experts demonstrated significantly higher agreement compared to either trainees (P < 0.001) or non-experts (P < 0.001). On the post-intervention survey, interobserver agreement remained low among both trainees (kappa = 0.20) and non-experts (kappa = 0.14). Comparing the results of the surveys, there was no evidence that agreement differed for either trainees or non-experts. Future efforts are needed to enable endoscopist recognition of BE HGD lesions. Consensus guidelines alone are insufficient in directing preferred endoscopic management of BE HGD.
    12/2014; 2(4):E207-11. DOI:10.1055/s-0034-1377516
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    Patrick Yachimski · Chin Hur ·
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    ABSTRACT: Barrett’s esophagus (BE) develops as a consequence of chronic esophageal acid exposure, and is the major risk factor for esophageal adenocarcinoma (EAC). The practices of endoscopic screening for—and surveillance of—BE, while widespread, have failed to reduce the incidence of EAC. The majority of EACs are diagnosed in patients without a known history of BE, and current diagnostic tools are lacking in their ability to stratify patients with BE into those at low risk and those at high risk for progression to malignancy. Nonetheless, advances in endoscopic imaging and mucosal therapeutics have provided unprecedented opportunities for intervention for BE, and have vastly altered the approach to management of BE-associated mucosal neoplasia.
    09/2014; 3(1). DOI:10.1093/gastro/gou059
  • Patrick Yachimski ·
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    ABSTRACT: Nearly a decade has elapsed since initial publication of a multicentre randomised trial of porfimer sodium photodynamic therapy (psPDT) for the treatment of Barrett's oesophagus (BO) containing high-grade dysplasia (HGD).1 With the addition of endoscopic mucosal resection (EMR) and radiofrequency ablation (RFA) to the therapeutic armamentarium, a seismic shift has now ensued in the treatment landscape of BO-associated mucosal neoplasia. An ever-increasing proportion of patients with BO HGD or T1 oesophageal adenocarcinoma (OAC), opt for endoscopic therapy rather than surgery.2 Durable disease remission is achievable for the majority of patients, with most instances of recurrence being amenable to further endoscopic management and with low rates of salvage oesophagectomy or oesophageal cancer-related mortality.3 Compared with a significant post-treatment stricture rate (>30% for PDT1) and prolonged duration of photosensitivity following psPDT, the relatively lower toxicity profile of newer-generation endoscopic therapies (<10% stricture rate for RFA4) has enabled consideration of whether prophylactic endoscopic therapy may be offered, in lieu of surveillance, to an expanded treatment pool of patients with pathology less advanced than HGD. Indeed, an endoscopic ablation strategy for BO has been envisioned as analogous to the widespread practice of screening colonoscopy and resection of adenomatous polyps for prevention of colorectal cancer.5 Yet at the same time, epidemiological investigation has prompted a recalibration of the risk of BO neoplastic progression. An annual progression rate from non-dysplastic BO to OAC of 0.12% was reported from a … [Full text of this article]
    Gut 08/2014; 64(5). DOI:10.1136/gutjnl-2014-307969 · 14.66 Impact Factor

  • Gastroenterology 05/2014; 146(5):S-304. DOI:10.1016/S0016-5085(14)61091-X · 16.72 Impact Factor
  • Ashley Canipe · James C. Slaughter · Patrick S. Yachimski ·

    Gastroenterology 05/2014; 146(5):S-304. DOI:10.1016/S0016-5085(14)61092-1 · 16.72 Impact Factor
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    ABSTRACT: Background & Aims: Endoscopic intervention or pharmacologic inhibition of cyclooxygenase might be used to prevent progression of Barrett’s esophagus (BE) to esophageal adenocarcinoma (EAC). We investigated whether patients with BE prefer endoscopic therapy or chemoprevention of EAC. Methods Eighty-one subjects with nondysplastic BE were given a survey that described 2 scenarios. The survey explained that treatment A (ablation), endoscopy, reduced lifetime risk of EAC by 50%, with a 5% risk for esophageal stricture, whereas treatment B (aspirin) reduced lifetime risk of EAC by 50% and the risk of heart attack by 30%, yet increased the risk for ulcer by 75%. Subjects indicated their willingness to undergo either treatment A and/or treatment B if endoscopic surveillance was required every 3–5 years, every 10 years, or was not required. Visual aids were included to represent risk and benefit percentages. Results When surveillance was required every 3–5 years, more subjects were willing to undergo treatment A than treatment B (78% [63/81] vs 53% [43/81], P<.01). There were no differences in age, sex, education level, or history of cancer, heart disease, or ulcer between patients willing to undergo treatment A and those willing to undergo treatment B. Altering the frequency of surveillance did not affect patients’ willingness to undergo either treatment. Conclusion In a simulated scenario, patients with BE preferred endoscopic intervention over chemoprevention for EAC. Further investigation may be warranted of the shared decision making process regarding preventive strategies for patients with BE.
    Clinical gastroenterology and hepatology: the official clinical practice journal of the American Gastroenterological Association 03/2014; 13(1). DOI:10.1016/j.cgh.2014.03.017 · 7.90 Impact Factor
  • Eric Trawick · Safia Salaria · Patrick Yachimski ·

    Gastrointestinal endoscopy 01/2014; 79(5). DOI:10.1016/j.gie.2013.11.036 · 5.37 Impact Factor
  • Article: Response.
    Lisa Cassani · Patrick Yachimski ·

    Gastrointestinal endoscopy 01/2014; 79(1):181. DOI:10.1016/j.gie.2013.08.025 · 5.37 Impact Factor
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    Patrick Yachimski ·
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    ABSTRACT: Narrowband imaging (NBI) is an enhanced endoscopic optical technique which filters white light and accentuates imaging of the mucosal vasculature. Potential clinical applications of NBI include endoscopic inspection of Barrett's esophagus and endoscopic diagnosis of colorectal polyps. The degree to which NBI use has been adopted into clinical practice is unknown. The study objective was to identify the rate of NBI use in patients undergoing elective esophagoduodenoscopy (EGD) and colonoscopy, and to identify procedural factors associated with NBI use. Elective endoscopic procedures were prospectively observed over a 2-week study period. NBI use during diagnostic EGD or colonoscopy was recorded in blinded fashion. NBI use was observed in 6.6 % (21/318) of procedures, including 4.7 % (5/106) of EGDs and 7.5 % (16/212) of colonoscopies. There was no difference in rate of NBI use when comparing EGD with or without biopsy, or when comparing colonoscopy with or without biopsy. NBI use was significantly higher in colonoscopy with polypectomy compared with colonoscopy without polypectomy (13 % [10/77] vs. 4.4 % [6/135], P = 0.03). NBI use varied significantly among endoscopists. There was no association between patient type (outpatient vs. inpatient), procedure start time, sedation type, or trainee involvement and use/non-use of NBI. Procedural documentation of NBI use was limited. Conclusions NBI use was observed in 6.6 % of elective endoscopic procedures and was highest in colonoscopies with polypectomy. Rate of NBI use varied significantly among endoscopists. Additional studies are needed to assess the magnitude of impact of NBI on routine endoscopic practice.
    12/2013; 1(01):8-11. DOI:10.1055/s-0033-1359256
  • Patrick Yachimski · Chanjuan Shi · James C Slaughter · Mary Kay Washington ·
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    ABSTRACT: To report the prevalence of Subsquamous intestinal metaplasia (SSIM) in patients undergoing endoscopic mucosal resection (EMR) for staging of Barrett's esophagus (BE). Thirty-three patients with BE associated neoplasia underwent EMR at our institution between September 2009 and September 2011; 22 of these patients met study inclusion criteria. EMR was targeted at focal abnormalities within the BE segment. EMR was performed in standardized fashion using a cap-assisted band ligation technique, and resection specimens were assessed for the presence of SSIM. Demographic and clinical data were analyzed to determine predictors of SSIM. SSIM was detected in 59% of patients. SSIM was detected in 73% of patients with short segment (< 3 cm) BE, and in 45% of patients with long-segment (≥ 3 cm) BE (P = NS). There was no association between presence/absence of SSIM and age, gender, or stage of BE-associated neoplasia. EMR detects SSIM in a majority of patients with BE-associated neoplasia. While the long-term clinical significance of SSIM remains uncertain, these results highlight the importance of EMR as an optimal diagnostic tool for staging of BE and detection of SSIM, and should further limit concerns that SSIM is purely a post-ablation phenomenon.
    12/2013; 5(12):590-4. DOI:10.4253/wjge.v5.i12.590
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    Gastrointestinal Endoscopy 05/2013; 77(5):AB318. DOI:10.1016/j.gie.2013.03.1074 · 5.37 Impact Factor
  • Lisa Cassani · Eric Sumner · James C Slaughter · Patrick Yachimski ·
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    ABSTRACT: BACKGROUND: Accurate endoscopic detection and staging are critical for appropriate management of Barrett's esophagus (BE)-associated neoplasia. Prior investigation has demonstrated that the distribution of endoscopically detectable early neoplasia is not uniform but instead favors specific directional distributions within a short BE segment; however, it is unknown whether the directional distribution of neoplasia differs with increasing distance from the gastroesophageal junction, including in patients with long-segment BE. OBJECTIVE: To identify whether directional distribution of BE-associated neoplasia is influenced by distance from the gastroesophageal junction. DESIGN: Retrospective cohort study. SETTING: Tertiary-care referral center. PATIENTS: Patients with either short-segment or long-segment BE undergoing EMR. INTERVENTION: EMR. MAIN OUTCOME MEASUREMENTS: Directional distribution of BE-associated neoplasia stratified by distance from gastroesophageal junction. RESULTS: EMR was performed on 60 lesions meeting study criteria during the specified time period. Pathology demonstrated low-grade dysplasia in 22% (13/60), high-grade dysplasia in 38% (23/60), intramucosal (T1a) adenocarcinoma in 23% (14/60), and invasive (≥T1b) adenocarcinoma in 17% (10/60). Directional distribution of lesions was not uniform (P < .001), with 62% of lesions (37/60) located between the 1 o'clock and 5 o'clock positions. When circular statistics methodology was used, there was no difference in the directional distribution of neoplastic lesions located within 3 cm of the gastroesophageal junction compared with ≥3 cm from the gastroesophageal junction. LIMITATIONS: Single-center study may limit external validity. CONCLUSION: The directional distribution of neoplastic foci within a BE segment is not influenced by distance of the lesion from the gastroesophageal junction. Mucosa between the 1 o'clock and 5 o'clock locations merits careful attention and endoscopic inspection both in individuals with short-segment BE and long-segment BE.
    Gastrointestinal endoscopy 03/2013; 77(6). DOI:10.1016/j.gie.2013.01.026 · 5.37 Impact Factor
  • Katie Ayers · Chanjuan Shi · Kay Washington · Patrick Yachimski ·
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    ABSTRACT: Background: Endoscopic therapy has emerged as an alternative to surgical esophagectomy for the management of Barrett's esophagus (BE)-associated neoplasia. Accurate pretreatment staging is essential to ensure an appropriate choice of therapy and optimal long-term outcomes. This study aimed to assess the frequency with which expert histopathologic review of biopsies combined with endoscopic mucosal resection (EMR) would alter the pretreatment diagnosis of BE-associated neoplasia. Methods: Patients referred to the Vanderbilt Barrett's Esophagus Endoscopic Treatment Program (V-BEET) were retrospectively identified. Demographic, histopathologic, and endoscopic data were extracted from the medical record. Results: For this study, 29 subjects referred for endoscopic staging of BE fulfilled the entry criteria. The referral diagnosis was low-grade dysplasia (LGD) in 3 % (1/29), high-grade dysplasia (HGD) in 62 % (18/29), intramucosal adenocarcinoma (T1a) adenocarcinoma in 17 % (5/29), and invasive adenocarcinoma in 17 % (5/29) of the subjects. Expert histopathologic review of available referral biopsy specimens altered the diagnosis in 33 % (5/15) of the cases. Further diagnostic staging with EMR showed BE without dysplasia in 10 % (3/29), LGD in 14 % (4/29), HGD in 34 % (10/29), T1a adenocarcinoma in 28 % (8/29), and invasive adenocarcinoma in 14 % (4/29) of the patients. The combination of expert histopathologic review and EMR altered the initial diagnosis for 55 % (16/29) of the subjects, with 56 % (9/16) upstaged to more advanced disease and 44 % (7/16) downstaged to less advanced disease. Conclusions: The practice of combined expert histopathologic review and EMR alters the pretreatment diagnosis for the majority of patients with BE-associated neoplasia. Caution is advised for those embarking on endoscopic or surgical treatment for BE-associated neoplasia in the absence of these staging methods.
    Surgical Endoscopy 02/2013; 27(8). DOI:10.1007/s00464-013-2830-x · 3.26 Impact Factor
  • Eric P. Trawick · Katie I. Ayers · James C. Slaughter · Patrick S. Yachimski ·

    Gastrointestinal Endoscopy 04/2012; 75(4):AB360. DOI:10.1016/j.gie.2012.03.942 · 5.37 Impact Factor
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    Eric P Trawick · Patrick S Yachimski ·
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    ABSTRACT: Upper gastrointestinal tract hemorrhage (UGIH) remains a common presentation requiring urgent evaluation and treatment. Accurate assessment, appropriate intervention and apt clinical skills are needed for proper management from time of presentation to discharge. The advent of pharmacologic acid suppression, endoscopic hemostatic techniques, and recognition of Helicobacter pylori as an etiologic agent in peptic ulcer disease (PUD) has revolutionized the treatment of UGIH. Despite this, acute UGIH still carries considerable rates of morbidity and mortality. This review aims to discuss current areas of uncertainty and controversy in the management of UGIH. Neoadjuvant proton pump inhibitor (PPI) therapy has become standard empiric treatment for UGIH given that PUD is the leading cause of non-variceal UGIH, and PPIs are extremely effective at promoting ulcer healing. However, neoadjuvant PPI administration has not been shown to affect hard clinical outcomes such as rebleeding or mortality. The optimal timing of upper endoscopy in UGIH is often debated. Upon completion of volume resuscitation and hemodynamic stabilization, upper endoscopy should be performed within 24 h in all patients with evidence of UGIH for both diagnostic and therapeutic purposes. With rising healthcare cost paramount in today's medical landscape, the ability to appropriately triage UGIH patients is of increasing value. Upper endoscopy in conjunction with the clinical scenario allows for accurate decision making concerning early discharge home in low-risk lesions or admission for further monitoring and treatment in higher-risk lesions. Concomitant pharmacotherapy with non-steroidal anti-inflammatory drugs (NSAIDs) and antiplatelet agents, such as clopidogrel, has a major impact on the etiology, severity, and potential treatment of UGIH. Long-term PPI use in patients taking chronic NSAIDs or clopidogrel is discussed thoroughly in this review.
    World Journal of Gastroenterology 03/2012; 18(11):1159-65. DOI:10.3748/wjg.v18.11.1159 · 2.37 Impact Factor
  • Patrick Yachimski · Gary W Falk ·
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    ABSTRACT: Buried Barrett's, or subsquamous intestinal metaplasia (SSIM), is defined as the presence of metaplastic, columnar tissue beneath overlying squamous epithelium. Therefore, SSIM cannot be detected by endoscopic visual examination alone; it is detectable only by tissue biopsy. SSIM can develop in patients with Barrett's esophagus (BE) after chronic pharmacologic suppression of gastric acid; it has been identified before and after endoscopic ablative therapies in cohort studies. It is important to determine the malignant potential of SSIM and the effects of endoscopic therapy for BE on development of SSIM; answers to these questions could affect long-term endoscopic surveillance and ablation strategies for patients with BE.
    Clinical gastroenterology and hepatology: the official clinical practice journal of the American Gastroenterological Association 03/2012; 10(3):220-4. DOI:10.1016/j.cgh.2011.10.009 · 7.90 Impact Factor
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    ABSTRACT: Cyclooxygenase-2 expression is upregulated in Barrett's esophagus and esophageal adenocarcinoma. Photodynamic therapy using porfimer sodium can result in ablation of dysplasia and intramucosal carcinoma, eradication of Barrett's esophagus, and restitution of squamous epithelium. The aim of this study was to determine the effect of photodynamic therapy on cyclooxygenase-2 expression in esophageal epithelium. Paired pre- and post-photodynamic therapy biopsy samples from the same anatomical levels of 20 individuals who had undergone photodynamic therapy for Barrett's esophagus with high-grade dysplasia and/or intramucosal carcinoma were immunostained using a cyclooxygenase-2 monoclonal antibody. Cyclooxygenase-2 expression was graded in squamous epithelium, Barrett's esophagus, and neoplasia (if present) as follows: grade 0 (no staining), grade 1 (staining in 1-10% of cells), grade 2 (staining in 11-90% of cells), and grade 3 (staining in >90% of cells). Pre-photodynamic therapy median cyclooxygenase-2 expression was grade 2 (range 1-3) in neoplastic foci and grade 1 (range 1-3) in nondysplastic Barrett's esophagus (P=0.0009 for pairwise comparison). With the exception of a few cells staining in the basal epithelial layers, median cyclooxygenase-2 expression was graded as 0 (similar to controls) in both pre-photodynamic therapy squamous epithelium and post-photodynamic therapy neosquamous epithelium. This was significantly lower when compared to either neoplastic foci (P<0.0001) or nondysplastic Barrett's esophagus (P<0.0001) pre-photodynamic therapy. Notably, in four patients with post-photodynamic therapy recurrent neoplasia, cyclooxygenase-2 expression returned to elevated levels. Cyclooxygenase-2 expression is elevated in Barrett's esophagus with high-grade dysplasia or intramucosal carcinoma prior to photodynamic therapy. Following successful photodynamic therapy, cyclooxygenase-2 expression in neosquamous epithelium returns to a low baseline level similar to that observed in native esophageal squamous epithelium. Post-photodynamic therapy neoplastic recurrence is associated with elevated cyclooxygenase-2 expression. Prospective studies should determine whether cyclooxygenase inhibitors have a role as adjuvant therapy to prevent recurrence of Barrett's esophagus following endoscopic therapy.
    Archiv für Pathologische Anatomie und Physiologie und für Klinische Medicin 11/2011; 459(6):581-6. DOI:10.1007/s00428-011-1167-x · 2.65 Impact Factor

Publication Stats

444 Citations
357.93 Total Impact Points


  • 2009-2015
    • Vanderbilt University
      • Division of Gastroenterology, Hepatology and Nutrition
      Нашвилл, Michigan, United States
  • 2008-2014
    • Harvard Medical School
      • Department of Medicine
      Boston, Massachusetts, United States
  • 2008-2011
    • Harvard University
      Cambridge, Massachusetts, United States
  • 2005-2009
    • Massachusetts General Hospital
      • • Department of Medicine
      • • Wellman Center for Photomedicine
      Boston, Massachusetts, United States