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Thomas Imperiale, MD

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Gastroenterology

Professor of Medicine

Academic Office

Regenstrief Health Center, Room 5th Floor
1050 Wishard Blvd.
Indianapolis IN 46202-2859 Map

Contact Information

Phone: (317) 274-9046
Fax: (317) 278-0164
Email:

Research Interests

Technology assessment for digestive diseases, Colorectal cancer screening, Use of clinical prediction rules in clinical decision making

Clinical Interests

General gastroenterology and hepatology, Acute upper gastrointestinal bleeding, Colorectal cancer screening

Education and Training

Fellowship Yale University
Residency Case Western Reserve University
Medicine (M.D.) Case Western Reserve University
Biology, General City College Of New York, The (Cuny)

Board Certifications

Internal Medicine 1984
Gastroenterology 1995

Publications (48)¹

Multi-Center Colonoscopy Quality Measurement Utilizing Natural Language Processing.
Journal: The American journal of gastroenterology
Authors: Imler TD; Morea J; Kahi C; Cardwell J; Johnson CS; Xu H; Ahnen D; Antaki F; Ashley C; Baffy G; Cho I; Dominitz J; Hou J; Korsten M; Nagar A; Promrat K; Robertson D; Saini S; Shergill A; Smalley W; Imperiale TF;
Publication Date: 2015 Mar 10

Abstract

An accurate system for tracking of colonoscopy quality and surveillance intervals could improve the effectiveness and cost-effectiveness of colorectal cancer (CRC) screening and surveillance. The purpose of this study was to create and test such a system across multiple institutions utilizing natural language processing (NLP).
View details for PubMedID 25756240
Current and future applications of natural language processing in the field of digestive diseases.
Journal: Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association
Authors: Hou JK; Imler TD; Imperiale TF;
Publication Date: 2014 May 21

Abstract

Natural language processing (NLP) is a technology that uses computer-based linguistics and artificial intelligence to identify and extract information from free-text data sources such as progress notes, procedure and pathology reports, and laboratory and radiologic test results. With the creation of large databases and the trajectory of health care reform, NLP holds the promise of enhancing the availability, quality, and utility of clinical information with the goal of improving documentation, quality, and efficiency of health care in the United States. To date, NLP has shown promise in automatically determining appropriate colonoscopy intervals and identifying cases of inflammatory bowel disease from electronic health records. The objectives of this review are to provide background on NLP and its associated terminology, to describe how NLP has been used thus far in the field of digestive diseases, and to identify its potential future uses.
View details for PubMedID 24858706
Multitarget stool DNA testing for colorectal-cancer screening.
Journal: The New England journal of medicine
Authors: Imperiale TF; Ransohoff DF; Itzkowitz SH; Levin TR; Lavin P; Lidgard GP; Ahlquist DA; Berger BM;
Publication Date: 2014 Mar 19

Abstract

An accurate, noninvasive test could improve the effectiveness of colorectal-cancer screening.
View details for PubMedID 24645800
Genetic pathways, prevention, and treatment of sporadic colorectal cancer.
Journal: Oncoscience
Authors: Mundade R; Imperiale TF; Prabhu L; Loehrer PJ; Lu T;
Publication Date: 2014 Jun 30

Abstract

Epithelial cancer of the colon and rectum, also known as colorectal cancer (CRC), results from a progressive accumulation of genetic and epigenetic alterations that lead to uncontrolled growth of colonocytes, the cells lining the colon and rectum. CRC is the second leading cause of cancer-related deaths and the third most common cancer in men and in women in the U.S. Of all the patients diagnosed with CRC every year, it is estimated that the vast majority of CRCs are non-hereditary "sporadic cancers" with no apparent evidence of an inherited component. Sporadic CRC results from the cumulative effects of multiple genetic and epigenetic alterations caused by somatic mutations, which may themselves be the indirect result of several environmental factors. This review examines our current understanding of the major genetic alterations leading to colon cancer, options for prevention and early detection of CRC, and the currently available treatment approaches that may target these different genetic alterations.
View details for PubMedID 25594038
A risk index for advanced neoplasia on the second surveillance colonoscopy in patients with previous adenomatous polyps.
Journal: Gastrointestinal endoscopy
Authors: Imperiale TF; Juluri R; Sherer EA; Glowinski EA; Johnson CS; Morelli MS;
Publication Date: 2014 Jun 2

Abstract

Predicting the risk of advanced colorectal neoplasia on the second surveillance colonoscopy could help tailor surveillance.
View details for PubMedID 24890416
Yield of the second surveillance colonoscopy based on the results of the index and first surveillance colonoscopies.
Journal: Endoscopy
Authors: Morelli MS; Glowinski EA; Juluri R; Johnson CS; Imperiale TF;
Publication Date: 2013 Sep 9

Abstract

The risk of advanced colorectal neoplasia (ACN) after the first surveillance colonoscopy is not well quantified. The aim of the current study was to quantify the risk of ACN on the second surveillance colonoscopy based on previous colonoscopic findings.
View details for PubMedID 24019133
Prevalence of malignancy in patients with pure main duct intraductal papillary mucinous neoplasms.
Journal: Gastrointestinal endoscopy
Authors: Abdeljawad K; Vemulapalli KC; Schmidt CM; Dewitt J; Sherman S; Imperiale TF; Al-Haddad M;
Publication Date: 2013 Oct 3

Abstract

Risk of malignancy in main duct intraductal papillary mucinous neoplasm (MD-IPMN) ranges from 36% to 100% in the literature. Although surgical resection is recommended for all MD-IPMNs, the risk of malignancy based on main pancreatic duct (MPD) size alone remains unclear.
View details for PubMedID 24094923
Treatment of esophageal leaks, fistulae, and perforations with temporary stents: evaluation of efficacy, adverse events, and factors associated with successful outcomes.
Journal: Gastrointestinal endoscopy
Authors: El Hajj II; Imperiale TF; Rex DK; Ballard D; Kesler KA; Birdas TJ; Fatima H; Kessler WR; DeWitt JM;
Publication Date: 2013 Oct 11

Abstract

Factors associated with successful endoscopic therapy with temporary stents for esophageal leaks, fistulae, and perforations (L/F/P) are not well known.
View details for PubMedID 24125513
Association between body mass index and quality of split bowel preparation.
Journal: Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association
Authors: Fayad NF; Kahi CJ; Abd El-Jawad KH; Shin AS; Shah S; Lane KA; Imperiale TF;
Publication Date: 2013 Jun 28

Abstract

Little is known about the association between obesity and bowel preparation. We investigated whether body mass index (BMI) is an independent risk factor for inadequate bowel preparation in patients who receive split preparation regimens.
View details for PubMedID 23811246
Performance characteristics of molecular (DNA) analysis for the diagnosis of mucinous pancreatic cysts.
Journal: Gastrointestinal endoscopy
Authors: Al-Haddad M; DeWitt J; Sherman S; Schmidt CM; LeBlanc JK; McHenry L; Coté G; El Chafic AH; Luz L; Stuart JS; Johnson CS; Klochan C; Imperiale TF;
Publication Date: 2013 Jul 9

Abstract

Diagnosis of mucinous pancreatic cysts (MPCs) is challenging due to the poor sensitivity of cytology provided by EUS-guided-FNA (EUS-FNA).
View details for PubMedID 23845445
Natural language processing accurately categorizes findings from colonoscopy and pathology reports.
Journal: Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association
Authors: Imler TD; Morea J; Kahi C; Imperiale TF;
Publication Date: 2013 Jan 11

Abstract

Little is known about the ability of natural language processing (NLP) to extract meaningful information from free-text gastroenterology reports for secondary use.
View details for PubMedID 23313839
After a negative screening colonoscopy, a microsimulation model shows that currently recommended strategies are equally effective for rescreening.
Journal: Evidence-based medicine
Authors: Imperiale TF;
Publication Date: 2013 Feb 6
Patient understanding of benefits, risks, and alternatives to screening colonoscopy.
Journal: Family medicine
Authors: Schwartz PH; Edenberg E; Barrett PR; Perkins SM; Meslin EM; Imperiale TF;
Publication Date: 2013 Feb

Abstract

While several tests and strategies are recommended for colorectal cancer (CRC) screening, studies suggest that primary care providers often recommend colonoscopy without providing information about its risks or alternatives. These observations raise concerns about the quality of informed consent for screening colonoscopy.
View details for PubMedID 23378074
Lower endoscopy reduces colorectal cancer incidence in older individuals.
Journal: Gastroenterology
Authors: Kahi CJ; Myers LJ; Slaven JE; Haggstrom D; Pohl H; Robertson DJ; Imperiale TF;
Publication Date: 2013 Dec 4

Abstract

In older individuals, there are unclear effects of lower endoscopy on incidence of colorectal cancer (CRC) and of colonoscopy on site of CRC. We investigated whether sigmoidoscopy or colonoscopy is associated with a decreased incidence of CRC in older individuals, and whether the effect of colonoscopy differs by anatomic location.
View details for PubMedID 24316263
Clinical decision support with natural language processing facilitates determination of colonoscopy surveillance intervals.
Journal: Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association
Authors: Imler TD; Morea J; Imperiale TF;
Publication Date: 2013 Dec 4

Abstract

With an increased emphasis on improving quality and decreasing costs, new tools are needed to improve adherence to evidence-based practices and guidelines in endoscopy. We investigated the ability of an automated system that uses natural language processing (NLP) and clinical decision support (CDS) to facilitate determination of colonoscopy surveillance intervals.
View details for PubMedID 24316106
Can Streamlined Multicriteria Decision Analysis Be Used to Implement Shared Decision Making for Colorectal Cancer Screening?
Journal: Medical decision making : an international journal of the Society for Medical Decision Making
Authors: Dolan JG; Boohaker E; Allison J; Imperiale TF;
Publication Date: 2013 Dec 3

Abstract

Current US colorectal cancer screening guidelines that call for shared decision making regarding the choice among several recommended screening options are difficult to implement. Multicriteria decision analysis (MCDA) is an established method well suited for supporting shared decision making. Our study goal was to determine whether a streamlined form of MCDA using rank-order-based judgments can accurately assess patients' colorectal cancer screening priorities.
View details for PubMedID 24300851
Lower provider volume is associated with higher failure rates for endoscopic retrograde cholangiopancreatography.
Journal: Medical care
Authors: Coté GA; Imler TD; Xu H; Teal E; French DD; Imperiale TF; Rosenman MB; Wilson J; Hui SL; Sherman S;
Publication Date: 2013 Dec

Abstract

Among physicians who perform endoscopic retrograde cholangiopancreatography (ERCP), the relationship between procedure volume and outcome is unknown.
View details for PubMedID 24226304
Promoting colorectal cancer screening discussion: a randomized controlled trial.
Journal: American journal of preventive medicine
Authors: Christy SM; Perkins SM; Tong Y; Krier C; Champion VL; Skinner CS; Springston JK; Imperiale TF; Rawl SM;
Publication Date: 2013 Apr

Abstract

Provider recommendation is a predictor of colorectal cancer (CRC) screening.
View details for PubMedID 23498096
Similar efficacies of biliary, with or without pancreatic, sphincterotomy in treatment of idiopathic recurrent acute pancreatitis.
Journal: Gastroenterology
Authors: Coté GA; Imperiale TF; Schmidt SE; Fogel E; Lehman G; McHenry L; Watkins J; Sherman S;
Publication Date: 2012 Sep 11

Abstract

The role of sphincter of Oddi manometry (SOM) in the management of patients with idiopathic recurrent acute pancreatitis requires clarification. We evaluated the therapeutic effects of endoscopic sphincterotomy in patients with recurrent acute pancreatitis and the prognostic significance of pancreatic sphincter dysfunction (SOD).
View details for PubMedID 22982183
Tailoring colorectal cancer screening by considering risk of advanced proximal neoplasia.
Journal: The American journal of medicine
Authors: Imperiale TF; Glowinski EA; Lin-Cooper C; Ransohoff DF;
Publication Date: 2012 Oct 9

Abstract

Quantifying the risk of advanced proximal colorectal neoplasia might allow tailoring of colorectal cancer screening, with colonoscopy for those at high risk and less invasive screening for very low-risk persons.
View details for PubMedID 23062404
Second-look endoscopy for bleeding peptic ulcer disease: a decision-effectiveness and cost-effectiveness analysis.
Journal: Journal of clinical gastroenterology
Authors: Imperiale TF; Kong N;
Publication Date: 2012 Oct

Abstract

Second-look endoscopy after initial therapeutic endoscopy for bleeding peptic ulcer disease may decrease the risk of rebleeding; however, it is not recommended routinely. Understanding conditions under which second-look endoscopy is beneficial might be useful for clinical decision making.
View details for PubMedID 22298087
Noninvasive screening tests for colorectal cancer.
Journal: Digestive diseases (Basel, Switzerland)
Authors: Imperiale TF;
Publication Date: 2012 Nov 23

Abstract

Identifying an accurate, reliable, affordable, and acceptable noninvasive screening test for colorectal cancer (CRC) would greatly facilitate population screening.
View details for PubMedID 23207928
Risk for colorectal cancer in persons with a family history of adenomatous polyps: a systematic review.
Journal: Annals of internal medicine
Authors: Imperiale TF; Ransohoff DF;
Publication Date: 2012 May 15

Abstract

The risk for colorectal cancer (CRC) is unclear for persons who have first-degree relatives with adenomatous polyps (adenomas).
View details for PubMedID 22586009
Deep sedation in natural orifice transluminal endoscopic surgery (NOTES): a comparative study with dogs.
Journal: Surgical endoscopy
Authors: Al-Haddad M; McKenna D; Ko J; Sherman S; Selzer DJ; Mattar SG; Imperiale TF; Rex DK; Nakeeb A; Jeong SM; Johnson CS; Freeman LJ;
Publication Date: 2012 May 12

Abstract

Natural orifice transluminal endoscopic surgery (NOTES) has been mostly performed with the animal under general and inhalational anesthesia (IA-NOTES). To date, NOTES using propofol sedation (PS-NOTES) has not been investigated. This study aimed to assess the feasibility and safety of PS-NOTES for transgastric oophorectomy with carbon dioxide insufflation and to compare its success rates with those of conventional IA-NOTES.
View details for PubMedID 22580877
Computer-delivered tailored intervention improves colon cancer screening knowledge and health beliefs of African-Americans.
Journal: Health education research
Authors: Rawl SM; Skinner CS; Perkins SM; Springston J; Wang HL; Russell KM; Tong Y; Gebregziabher N; Krier C; Smith-Howell E; Brady-Watts T; Myers LJ; Ballard D; Rhyant B; Willis DR; Imperiale TF; Champion VL;
Publication Date: 2012 Aug 27

Abstract

We conducted a randomized controlled trial among African-American patients attending a primary-care provider visit to compare efficacy of a computer-delivered tailored intervention to increase colorectal cancer (CRC) screening (n = 273) with non-tailored print material-an American Cancer Society brochure on CRC screening (n = 283). Health Belief Model constructs were used to develop tailored messages and examined as outcomes. Analysis of covariance models were used to compare changes between CRC knowledge and health belief scores at baseline and 1 week post-intervention. At 1 week, patients who received the computer-delivered tailored intervention had greater changes in CRC knowledge scores (P < 0.001), perceived CRC risk scores (P = 0.005), FOBT barriers scores (P = 0.034) and colonoscopy benefit scores (P < 0.001). Findings show that computer-delivered tailored interventions are an effective adjunct to the clinical encounter that can improve knowledge and health beliefs about CRC screening, necessary precursors to behavior change.
View details for PubMedID 22926008
A quantitative assessment of the risks and cost savings of forgoing histologic examination of diminutive polyps.
Journal: Endoscopy
Authors: Kessler WR; Imperiale TF; Klein RW; Wielage RC; Rex DK;
Publication Date: 2011 May 27

Abstract

Endoscopic prediction of polyp histology is rapidly improving to the point where it may not be necessary to submit all polyps for formal histologic assessment. This study aimed to quantify the expected costs and outcomes of removing diminutive polyps without subsequent pathologic assessment.
View details for PubMedID 21623556
The effect of colonoscopy preparation quality on adenoma detection rates.
Journal: Gastrointestinal endoscopy
Authors: Sherer EA; Imler TD; Imperiale TF;
Publication Date: 2011 Dec 3

Abstract

Colonoscopy reduces the risk of colorectal cancer mortality by removing precancerous adenomas. The detection rate of subcentimeter (<10 mm) polyps is lower for procedures with inadequate preparation quality.
View details for PubMedID 22138085
Polyethylene glycol vs. sodium phosphate for bowel preparation: a treatment arm meta-analysis of randomized controlled trials.
Journal: BMC gastroenterology
Authors: Juluri R; Eckert G; Imperiale TF;
Publication Date: 2011 Apr 14

Abstract

Results of meta-analyses of randomized trials comparing PEG and NaP are inconsistent and have not included trials comparing either or both preps to less traditional ones.
View details for PubMedID 21492418
Continue or discontinue warfarin for fecal occult blood testing in 2010? Does the published evidence provide an answer?
Journal: The American journal of gastroenterology
Authors: Imperiale TF;
Publication Date: 2010 Sep

Abstract

Whether to continue or discontinue warfarin before fecal occult blood testing (FOBT) requires comparison of the risks and benefits of both choices. Clinical practice varies on this issue, and guidelines are silent. A small body of evidence about the effect of warfarin on test characteristics of FOBT is inconclusive, although it suggests no effect. Retrospective studies on this topic may be prone to transfer bias, which affects the composition of the groups assembled for study. Considering the risks and benefits of discontinuing warfarin qualitatively, along with the published literature and clinical context in 2010, where tolerance for false-positive results is higher than it used to be and where immunochemical FOBT is a better screening test than older, guaiac-based FOBT, "no" seems like the "commonsense" answer.
View details for PubMedID 20818354
Understanding differences in the guidelines for colorectal cancer screening.
Journal: Gastroenterology
Authors: Imperiale TF; Ransohoff DF;
Publication Date: 2010 Mar 16

Abstract

In this issue of Gastroenterology, the editors present 2 expert perspectives on the colorectal screening guidelines published in the May 2008 issue of the journal.
View details for PubMedID 20302867
High-definition chromocolonoscopy vs. high-definition white light colonoscopy for average-risk colorectal cancer screening.
Journal: The American journal of gastroenterology
Authors: Kahi CJ; Anderson JC; Waxman I; Kessler WR; Imperiale TF; Li X; Rex DK;
Publication Date: 2010 Feb 23

Abstract

Flat and depressed colon neoplasms are an increasingly recognized precursor for colorectal cancer (CRC) in Western populations. High-definition chromoscopy is used to increase the yield of colonoscopy for flat and depressed neoplasms; however, its role in average-risk patients undergoing routine screening remains uncertain.
View details for PubMedID 20179689
Meta-analysis: randomized controlled trials of 4-L polyethylene glycol and sodium phosphate solution as bowel preparation for colonoscopy.
Journal: Alimentary pharmacology & therapeutics
Authors: Juluri R; Eckert G; Imperiale TF;
Publication Date: 2010 Apr 7

Abstract

Randomized controlled trials (RCTs) comparing polyethylene glycol (PEG) with sodium phosphate (NaP) are inconsistent.
View details for PubMedID 20384609
Provider recommendations for colorectal cancer screening in elderly veterans.
Journal: Journal of general internal medicine
Authors: Kahi CJ; van Ryn M; Juliar B; Stuart JS; Imperiale TF;
Publication Date: 2009 Sep 18

Abstract

Decisions regarding colorectal cancer (CRC) screening in the elderly depend on providers' assessment of likelihood of benefit partly based on patient comorbidity and past screening history. We aimed to describe providers' experiences and practice patterns regarding screening for CRC in elderly patients in the VA system.
View details for PubMedID 19763698
Tocolytic therapy: a meta-analysis and decision analysis.
Journal: Obstetrics and gynecology
Authors: Haas DM; Imperiale TF; Kirkpatrick PR; Klein RW; Zollinger TW; Golichowski AM;
Publication Date: 2009 Mar

Abstract

To determine the optimal first-line tocolytic agent for treatment of premature labor.
View details for PubMedID 19300321
Endoscopist-directed administration of propofol: a worldwide safety experience.
Journal: Gastroenterology
Authors: Rex DK; Deenadayalu VP; Eid E; Imperiale TF; Walker JA; Sandhu K; Clarke AC; Hillman LC; Horiuchi A; Cohen LB; Heuss LT; Peter S; Beglinger C; Sinnott JA; Welton T; Rofail M; Subei I; Sleven R; Jordan P; Goff J; Gerstenberger PD; Munnings H; Tagle M; Sipe BW; Wehrmann T; Di Palma JA; Occhipinti KE; Barbi E; Riphaus A; Amann ST; Tohda G; McClellan T; Thueson C; Morse J; Meah N;
Publication Date: 2009 Jun 21

Abstract

Endoscopist-directed propofol sedation (EDP) remains controversial. We sought to update the safety experience of EDP and estimate the cost of using anesthesia specialists for endoscopic sedation.
View details for PubMedID 19549528
Variation in polyp detection rates at screening colonoscopy.
Journal: Gastrointestinal endoscopy
Authors: Imperiale TF; Glowinski EA; Juliar BE; Azzouz F; Ransohoff DF;
Publication Date: 2009 Jun

Abstract

Variation in polyp detection among endoscopists has been used to justify the need for establishing quality standards for colonoscopy performance.
View details for PubMedID 19481649
Effect of screening colonoscopy on colorectal cancer incidence and mortality.
Journal: Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association
Authors: Kahi CJ; Imperiale TF; Juliar BE; Rex DK;
Publication Date: 2009 Jan 11

Abstract

Colonoscopy is used widely for colorectal cancer (CRC) screening; however, its long-term impact on the incidence and mortality of CRC is not known.
View details for PubMedID 19268269
Five-year risk of colorectal neoplasia after negative screening colonoscopy.
Journal: The New England journal of medicine
Authors: Imperiale TF; Glowinski EA; Lin-Cooper C; Larkin GN; Rogge JD; Ransohoff DF;
Publication Date: 2008 Sep 18

Abstract

The appropriate interval for endoscopic rescreening after a negative colonoscopic examination is uncertain.
View details for PubMedID 18799558
Nurse-administered propofol sedation for upper endoscopic ultrasonography.
Journal: The American journal of gastroenterology
Authors: Fatima H; DeWitt J; LeBlanc J; Sherman S; McGreevy K; Imperiale TF;
Publication Date: 2008 Jun 28

Abstract

Limited data exist regarding the safety of nurse-administered propofol sedation (NAPS) for advanced endoscopy.
View details for PubMedID 18557709
Screening, surveillance, and primary prevention for colorectal cancer: a review of the recent literature.
Journal: Gastroenterology
Authors: Kahi CJ; Rex DK; Imperiale TF;
Publication Date: 2008 Jun 26
Nurse-administered propofol sedation compared with midazolam and meperidine for EUS: a prospective, randomized trial.
Journal: Gastrointestinal endoscopy
Authors: Dewitt J; McGreevy K; Sherman S; Imperiale TF;
Publication Date: 2008 Jun 17

Abstract

The utility of nurse-administered propofol sedation (NAPS) compared with midazolam and meperidine (M/M) for EUS is not known.
View details for PubMedID 18561925
Risk factors for advanced sporadic colorectal neoplasia in persons younger than age 50.
Journal: Cancer detection and prevention
Authors: Imperiale TF; Kahi CJ; Stuart JS; Qi R; Born LJ; Glowinski EA; Rex DK;
Publication Date: 2008 Apr 8

Abstract

Colorectal cancer (CRC) screening is recommended for average-risk adults beginning at age 50. However, 7% of CRC occurs in persons younger than age 50, a group for which risk factors are not well defined. We sought to determine whether a retrospective case-control study could identify risk factors for sporadic CRC and advanced adenomatous polyps (together known as sporadic colorectal neoplasia [CRN]).
View details for PubMedID 18400417
Survival of elderly persons undergoing colonoscopy: implications for colorectal cancer screening and surveillance.
Journal: Gastrointestinal endoscopy
Authors: Kahi CJ; Azzouz F; Juliar BE; Imperiale TF;
Publication Date: 2007 Sep

Abstract

In the elderly, the increased prevalence of colorectal neoplasia and the protective effect of colonoscopy may be offset by advancing age and comorbidity.
View details for PubMedID 17725944
Predicting poor outcome from acute upper gastrointestinal hemorrhage.
Journal: Archives of internal medicine
Authors: Imperiale TF; Dominitz JA; Provenzale DT; Boes LP; Rose CM; Bowers JC; Musick BS; Azzouz F; Perkins SM;
Publication Date: 2007 Jun 25

Abstract

Uncertainty about the outcome of acute upper gastrointestinal bleeding often results in a longer-than-necessary hospital stay.
View details for PubMedID 17592103
A multivariable model of clinical variables predicts advanced fibrosis in chronic hepatitis C.
Journal: Journal of clinical gastroenterology
Authors: Alsatie M; Kwo PY; Gingerich JR; Qi R; Eckert G; Cummings OW; Imperiale TF;
Publication Date: 2007 Apr

Abstract

A noninvasive method to identify advanced hepatic fibrosis (AHF) in chronic hepatitis C (CHC) could preclude the need for routine liver biopsy. Recent evidence suggests that obesity may contribute to hepatic fibrosis in hepatitis C virus infection.
View details for PubMedID 17413613
Cost-effectiveness analysis of variceal ligation vs. beta-blockers for primary prevention of variceal bleeding.
Journal: Hepatology (Baltimore, Md.)
Authors: Imperiale TF; Klein RW; Chalasani N;
Publication Date: 2007 Apr

Abstract

Although both beta-blockade (BB) and endoscopic variceal ligation (EVL) are used for primary prevention of variceal bleeding (VB) in patients with cirrhosis with moderate to large esophageal varices (EVs), the more cost-effective option is uncertain. We created a Markov decision model to compare BB and EVL in such patients, examining both cost-effectiveness (cost per life year [LY]) and cost-utility (cost per quality-adjusted life year [QALY]). Outcomes included cost per LY, cost per QALY, proportions of persons with VB, TIPS, and all-cause mortality. EVL and BB were compared using the incremental cost-effectiveness ratio (ICER) and incremental cost-utility ratio (ICUR). When considering only LYs, initial EVL exceeds the benchmark of 50,000 dollars/LY, with an ICER of 98,407 dollars. However, when quality of life (QoL) is considered, EVL is cost-effective compared to BB (ICUR of 25,548 dollars/QALY). In sensitivity analysis, EVL is cost-effective if the yearly risk of EV bleeding is > or = 0.26 (base case 0.15), the relative risk of bleeding on BB is > or = 0.69 (base case 0.58), or if the relative risk of bleeding with EVL is < 0.27 (base case 0.35). The ICUR favored EVL unless the relative risk of bleeding on BB is < 0.46, the relative risk of bleeding with EVL is > 0.46, or the time horizon is < or = 24 months. Whether EVL is "cost-effective" relative to BB therapy for primary prevention of EV bleeding depends on whether LYs or QALYs are considered. If only LYs are considered, then EVL is not cost-effective compared to BB therapy; however, if QoL is considered, then EVL is cost-effective.
View details for PubMedID 17393528
Comparison of endoscopic ultrasound and computed tomography for the preoperative evaluation of pancreatic cancer: a systematic review.
Journal: Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association
Authors: Dewitt J; Devereaux BM; Lehman GA; Sherman S; Imperiale TF;
Publication Date: 2006 May 3

Abstract

It is uncertain whether computed tomography (CT) or endoscopic ultrasound (EUS) is superior for the detection, staging, and resectability of pancreatic cancer. We therefore performed a systematic literature review to determine which test is more accurate.
View details for PubMedID 16675307
Endoscopic therapy versus medical therapy for bleeding peptic ulcer with adherent clot: a meta-analysis.
Journal: Gastroenterology
Authors: Kahi CJ; Jensen DM; Sung JJ; Bleau BL; Jung HK; Eckert G; Imperiale TF;
Publication Date: 2005 Sep

Abstract

The optimal management of bleeding peptic ulcer with adherent clot is controversial and may include endoscopic therapy or medical therapy.
View details for PubMedID 16143125