Avin Aggarwal

Interests

Teaching

Active hands on technical training for endoscopic procedures and didactic sessions to training GI fellows.Teaching residents, grand rounds for medicine department and ACP meetings. Mentoring fellows and IM residentsAmbulatory clinical rotation for medical students in clinic.

Research

Quality improvement studies, clinical research with clinical trials and innovation in GI related studies.

Courses

No activities entered.

Scholarly Contributions

Journals/Publications

• Bomman, S., Klair, J. S., Canakis, A., Muthusamy, A. K., Nagra, N., Chandra, S., Shanmugam, M., Perisetti, A., Aggarwal, A., Gavini, H. K., & Krishnamoorthi, R. (2024). Safety and Efficacy of Endoscopic Full Thickness Resection of Upper Gastrointestinal Lesions Using a Full Thickness Resection Device: A Systematic Review and Meta-analysis. Journal of clinical gastroenterology, 58(1), 46-52.
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  Endoscopic full-thickness resection (EFTR) is a promising technique that allows for a minimally invasive resection of mucosal and submucosal lesions in the gastrointestinal (GI) tract. The data regarding the efficacy and safety of performing EFTR of upper GI lesions using a full-thickness resection device (FTRD) is limited. Hence, we performed a systematic review and meta-analysis of the studies that evaluated this technique.
• Aggarwal, A. (2023).

  S175 Variability in Follow-up Recommendations After a Diagnostic Colonoscopy Performed for a Positive Multitarget Stool DNA Test

  . American Journal of Gastroenterology, 118(10S), S132-S133. doi:10.14309/01.ajg.0000950340.44957.29
• Andres, B., Babaria, R., Natali, S., & Aggarwal, A. (2023). Hepatic hydropericardium diagnosed via pericardiocentesis bubble study improves after transjugular intrahepatic portosystemic shunt placement. BMJ case reports, 16(9).
• Bains, K., Kalra, S., Singh, I., Patel, J., Kohli, I., Dhiman, M., Dukovic, D., Sohal, A., & Aggarwal, A. (2023). Prevalence and Impact of Malnutrition in Hospitalizations Among Celiac Diseases: A Nationwide Analysis. Cureus, 15(8), e44247.
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  Celiac disease (CD) is a T-cell-mediated gluten sensitivity that results in villous atrophy in the small intestine, leading to chronic malabsorption. Patients with celiac disease are prone to malnutrition. We assessed the impact of malnutrition on in-hospital outcomes in patients with CD.
• Aggarwal, A., Te, H. S., Verna, E. C., & Desai, A. P. (2021). A National Survey of Hepatocellular Carcinoma Surveillance Practices Following Liver Transplantation. Transplantation direct, 7(1), e638.
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  Recurrence of hepatocellular carcinoma (HCC) is an important predictor of survival after liver transplantation (LT). Recent studies show that early diagnosis, aggressive treatment, and surveillance may improve outcomes after HCC recurrence. We sought to determine the current practices and policies regarding surveillance for HCC recurrence after LT.
• Aggarwal, A. (2020). Liver transplantation for hepatocellular carcinoma: Management after the transplant. American Journal of Transplantation.
• Aggarwal, A., Desai, A. P., Verna, E. C., & Te, H. S. (2020). A National Survey of Hepatocellular Carcinoma Surveillance Practices Following Liver Transplantation. Transplantation direct. doi:10.1097/txd.0000000000001086
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  Recurrence of hepatocellular carcinoma (HCC) is an important predictor of survival after liver transplantation (LT). Recent studies show that early diagnosis, aggressive treatment, and surveillance may improve outcomes after HCC recurrence. We sought to determine the current practices and policies regarding surveillance for HCC recurrence after LT.We conducted a web-based national survey of adult liver transplant centers in the United States to capture center-specific details of HCC surveillance post-LT. Responses were analyzed to generate numerical and graphical summaries.Of 101 eligible adult liver transplant centers, 48 (48%) centers across the United States responded to the survey. Among the participating centers, 79% stratified transplant recipients for HCC recurrence risk, while 19% did not have any risk stratification protocol. Explant microvascular invasion (mVI) was the most common factor used in risk stratification. Use of pretransplant serum biomarkers such as alpha-fetoprotein (AFP) was variable, with only 48% of the participating centers reporting specific "cutoff" values. While a majority of centers (88%) reported having a routine imaging protocol for HCC recurrence surveillance, there was considerable heterogeneity in terms of frequency and duration of such surveillance. Of the centers that did risk stratify patients to identify those at higher risk of HCC recurrence, about 50% did not change their surveillance protocol.Our study affirms significant variability in center practices, and our results reflect the need for high-quality studies to guide risk stratification and surveillance for HCC recurrence.
• Rokkam, V. R., Aggarwal, A., & Taleban, S. (2020). Esophagitis Dissecans Superficialis: Malign Appearance of a Benign Pathology. Cureus, 12(6), e8475.
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  Esophagitis dissecans superficialis (EDS), also known as sloughing esophagitis, is a very rare condition and may affect the whole esophagus, resulting in complete sloughing of the mucous membrane. EDS has been associated with various medications and dermatological conditions. In our case, EDS was suspected secondary to methotrexate treatment in a patient with Crohn's disease, although the definitive etiology remains unknown. It is very important for physicians to recognize the endoscopic appearance of EDS to provide appropriate clinical management and differentiate it from other esophageal disorders.
• Verna, E. C., Patel, Y. A., Aggarwal, A., Desai, A. P., Frenette, C., Pillai, A. A., Salgia, R., Seetharam, A., Sharma, P., Sherman, C., Tsoulfas, G., & Yao, F. Y. (2020). Liver transplantation for hepatocellular carcinoma: Management after the transplant. American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons, 20(2), 333-347.
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  Hepatocellular carcinoma (HCC) is an increasingly common indication for liver transplantation (LT) in the United States and in many parts of the world. In the last decade, significant work has been done to better understand how to risk stratify LT candidates for recurrence of HCC following transplant using a combination of biomarker and imaging findings. However, despite the high frequency of HCC in the LT population, guidance regarding posttransplant management is lacking. In particular, there is no current evidence to support specific post-LT surveillance strategies, leading to significant heterogeneity in practices. In addition, there are no current recommendations regarding recurrence prevention, including immunosuppression regimen or secondary prevention with adjuvant chemotherapy. Finally, guidance on treatment of disease recurrence is also lacking and there is significant controversy about the use of immunotherapy in transplant recipients due to the risk of rejection. Thus, outcomes for patients with recurrence are poor. This paper therefore provides a comprehensive review of the current literature on post-LT management of patients with HCC and identifies gaps in our current knowledge that are in urgent need of further investigation.
• Aggarwal, A., Balogun, R., Carr, T. F., Desai, A. P., Jie, T., & Pan, J. J. (2019). Transfer of peanut allergy from donor to recipient after liver transplant. Annals of hepatology, 18(3), 508-513.
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  31 years old female with a history of contact dermatitis, eczema, allergic rhinitis, pernicious anemia, alopecia areata and latent tuberculosis was treated concurrently with methotrexate along with isoniazid and pyridoxine. Five months into the therapy she developed acute onset jaundice progressing into fulminant liver failure with altered mentation and worsening liver function tests. Extensive workup including serological and histopathological evaluation revealed drug-induced liver injury as the etiology of her liver failure and she underwent a successful orthotropic liver transplant. On post-transplant follow-up at four months, she was noted to have an allergic reaction consisting of a perioral rash and swelling (without anaphylaxis) after receiving a kiss from her significant other who had just eaten a peanut butter chocolate. She denied any history of allergic reaction to peanuts prior to the transplant. Percutaneous skin testing revealed immediate hypersensitivity to peanut, hazelnut, and pecan believed to be acquired newly post-transplant. Further investigation revealed that the organ donor had a documented history of systemic anaphylaxis from the peanut allergy and a positive peanut-specific IgE level. Also, another parallel solid organ recipient (lung transplant) from the same organ donor experienced a serious anaphylactic reaction after peanut exposure. This is a case of food (peanut) allergy transfer from the donor to the recipient after the liver transplant. This case highlights the importance of incorporating known donor allergies as a part of pre-transplant screening, given the potentially serious consequences from the transfer of allergies to a previously anergic recipient.
• Aggarwal, A., Brooling, J., Leal, R., Haluszka, O., & Mosadeghi, S. (2019). Sa1068 POST–POLYPECTOMY MEASUREMENT: A VIABLE ALTERNATIVE TO ENDOSCOPIC POLYP SIZE ESTIMATION. Gastrointestinal Endoscopy. doi:10.1016/j.gie.2019.03.086
• Aggarwal, A., Jaswal, N., Jain, R., & Elsiesy, H. (2019). Amoxicillin-clavulanate-induced Granulomatous Hepatitis: Case Report and Review of the Literature. Journal of clinical and translational hepatology, 7(3), 280-283.
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  Amoxicillin-clavulanate (AC) is a common cause of drug-induced liver injury, either cholestatic or mixed with hepatitis pattern. Rarely, AC causes granulomatous hepatitis. We report a new case of AC-induced granulomatous hepatitis documented by liver biopsy, with complete resolution of any histological sequelae on a follow-up liver biopsy after AC was withdrawn.
• Aggarwal, A., Rokkam, V. R., & Karasek, V. (2019). Atypical Gastric Ulcer With Impending Perforation due to Cocaine Use. ACG case reports journal, 6(9), e00218.
• Haeffele, C., Aggarwal, A., Lutchman, G., Veldtman, G. R., Wu, F. M., & Lui, G. K. (2019). Fontan Liver Lesions: Not Always HCC. JACC. Case reports, 1(2), 175-178.
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  A 24-year-old Fontan procedure patient underwent surveillance liver cardiac magnetic resonance imaging. Findings were suggestive of hepatocellular carcinoma (HCC). Currently, HCC is diagnosed based on imaging alone. Given her otherwise reassuring clinical profile, she underwent liver biopsy. Pathology demonstrated focal nodular hyperplasia. This raises concern for overdiagnosis of HCC in Fontan patients without tissue confirmation. ().
• Hu, C., Aggarwal, A., Banerjee, B., Kemmerly, T., Kim, D., & Wycoff, J. N. (2019). Su2059 – Novel Multi-View Imaging Device to Improve Colon Polyp Detection. Gastroenterology. doi:10.1016/s0016-5085(19)38681-0
• Seetharam, A., Aggarwal, A., Verna, E. C., Patel, Y. A., Desai, A. P., Frenette, C., Pillai, A. A., Salgia, R., Sharma, P., Sherman, C., Tsoulfas, G., & Yao, F. Y. (2019). Liver transplantation for hepatocellular carcinoma: Management after the transplant. American Journal of Transplantation, 20(2), 333-347. doi:10.1111/ajt.15697
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  Hepatocellular carcinoma (HCC) is an increasingly common indication for liver transplantation (LT) in the United States and in many parts of the world. In the last decade, significant work has been done to better understand how to risk stratify LT candidates for recurrence of HCC following transplant using a combination of biomarker and imaging findings. However, despite the high frequency of HCC in the LT population, guidance regarding posttransplant management is lacking. In particular, there is no current evidence to support specific post-LT surveillance strategies, leading to significant heterogeneity in practices. In addition, there are no current recommendations regarding recurrence prevention, including immunosuppression regimen or secondary prevention with adjuvant chemotherapy. Finally, guidance on treatment of disease recurrence is also lacking and there is significant controversy about the use of immunotherapy in transplant recipients due to the risk of rejection. Thus, outcomes for patients with recurrence are poor. This paper therefore provides a comprehensive review of the current literature on post-LT management of patients with HCC and identifies gaps in our current knowledge that are in urgent need of further investigation.
• Aggarwal, A., Yoo, E. R., Perumpail, R. B., Cholankeril, G., Kumari, R., Daugherty, T. J., Lapasaran, A. S., & Ahmed, A. (2017). Sofosbuvir Use in the Setting of End-stage Renal Disease: A Single Center Experience. Journal of clinical and translational hepatology, 5(1), 23-26.
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  Patients with chronic hepatitis C (CHC) and end-stage renal disease (ESRD) who are dialysis-dependent form a unique group, in which safety, tolerability and efficacy of sofosbuvir (SOF)-based direct-acting antivirals (DAAs) need further evaluation. We performed a retrospective analysis of 14 patients with CHC and ESRD on dialysis who received 15 courses of SOF-based therapy. We evaluated dose escalation to standard-dose SOF in this proof-of-principle experience. Sustained virological response (defined as undetectable viral load at 12 weeks, SVR-12) was achieved in 13 out of the 15 (86.7%) treatment courses. Seven (46.6%) patients received reduced half dose as conservative proof-of-principal to mitigate potential toxicity. In 13 out of 15 treatment courses, patients completed the designated treatment duration. One patient was treated twice and developed SVR-12 with the retreatment. One patient was lost to follow-up and counted as a non-responder. Premature discontinuations were not due to DAA-related adverse effects. There were no reports of severe adverse effects or drug interactions. We treated CHC patients with ESRD using dose escalation to standard-dose SOF in this proof-of-principle experience and achieved SVR rates comparable to general population.
• Tey, K. R., Aggarwal, A., & Banerjee, B. (2017). Migrating coil. BMJ case reports, 2017.
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  We describe a rare case of a 60-year-old man with known history of peptic ulcer disease who presented with melena and epigastric pain secondary to coil migration into duodenal mucosa 4 years after the initial therapeutic embolisation of the gastroduodenal artery. Upper endoscopy revealed oozing duodenal ulcer at the same site of the previously located duodenal ulcer 4 years ago and metal coil impacted at the duodenal mucosa. It is unclear if the coil migration is the effect or the cause of the bleeding duodenal ulcer. Our patient was treated by surgical intervention due to failed endoscopic haemostasis and medical management.
• Aggarwal, A., Ahmed, A., Younossi, Z. M., Perumpail, R. B., & Wong, R. J. (2016). 818 Hepatic Encephalopathy (HE): Impacting Waitlist Survival and Implications in Current Organ Allocation Policy for Liver Transplantation (LT). Gastroenterology. doi:10.1016/s0016-5085(16)33552-1
• Aggarwal, A., Perumpail, R. B., Tummala, S., & Ahmed, A. (2016). Hepatitis E virus infection in the liver transplant recipients: Clinical presentation and management. World journal of hepatology, 8(2), 117-22.
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  Hepatitis E virus (HEV) is an emerging pathogen and an increasingly recognized cause of graft hepatitis, especially in the post-orthotopic liver transplantation immunocompromised population. The exact incidence and prevalence of HEV infection in this population remains unclear but is certainly greater than historical estimates. Identifying acute HEV infection in this population is imperative for choosing the right course of management as it is very difficult to distinguish histologically from acute rejection on liver biopsy. Current suggested approach to manage acute HEV involves modifying immunosuppression, especially discontinuing calcineurin inhibitors which are the preferred immunosuppressive agents post-orthotopic liver transplantation. The addition of ribavirin monotherapy has shown promising success rates in clearing HEV infection and is used commonly in reported cases.
• Perumpail, R. B., Hahambis, T. A., Aggarwal, A., Younossi, Z. M., & Ahmed, A. (2016). Treatment strategies for chronic hepatitis C prior to and following liver transplantation. World journal of hepatology, 8(1), 69-73.
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  Hepatitis C virus (HCV)-related liver disease is the leading indication for liver transplantation (LT) worldwide. However, HCV is an independent predictor of lower survival following LT, and recurrence of HCV post-LT is virtually universal. The historic standard of care during the interferon era of HCV therapy was expectant management-initiation of antiviral therapy in the setting of documented disease progression following LT. With the advent of new direct acting antiviral (DAA) therapies for HCV, the paradigm of expectant treatment for recurrent HCV infection post-LT is shifting. The safety, tolerability, and efficacy of DAAs, even among the sickest patients with advanced liver disease, enables treatment of HCV in the pre-transplant setting among LT waitlist registrants. Finally, emerging data are supportive of preemptive therapy with DAAs in liver transplant recipients as the preferred approach. Expectant management of HCV following LT can rarely be justified in the modern era of HCV therapy.
• Aggarwal, A., & Garg, S. (2015). Diagnosing pseudoaneurysm of the gastroduodenal artery on endoscopic ultrasound. Endoscopy, 47 Suppl 1 UCTN, E404-5.
• Aggarwal, A., & Garg, S. (2015). Image Diagnosis: Inferior Mesenteric Vein Thrombosis. The Permanente journal, 19(3), e120-1.
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  A 59-year-old man presented to the gastroenterology clinic with 2 weeks of worsening lower back pain. There was associated poor appetite, fatigue, night sweats, and chills. The patient's medical history was significant for well-controlled hypertension and sigmoid diverticulosis. The thrombosis probably resulted from inflammation in the adjacent diverticulum.
• Aggarwal, A., & Garg, S. (2015). Isolated Pancreatic Histoplasmosis: An Unusual Suspect of Pancreatic Head Mass in an Immunocompetent Host. The Permanente journal, 19(4), e145-7.
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  Histoplasmosis is endemic to the Mississippi and Ohio River valley regions in the US. It usually affects patients with underlying immunodeficiency but can also be seen in immunocompetent hosts. Although gastrointestinal involvement is common in the setting of disseminated histoplasmosis, isolated gastrointestinal involvement is uncommon. We report a case of isolated pancreatic histoplasmosis in an immunocompetent patient, presenting as painless jaundice and pancreatic head mass.
• Aggarwal, A., Jazayeri, M. A., & Garg, S. (2015). Just Scratching the Surface: Intractable Nausea and Vomiting. The American journal of medicine, 128(11), e3-5.
• Jayasekera, C. R., Perumpail, R. B., Chao, D. T., Pham, E. A., Aggarwal, A., Wong, R. J., & Ahmed, A. (2015). Task-Shifting: An Approach to Decentralized Hepatitis C Treatment in Medically Underserved Areas. Digestive diseases and sciences, 60(12), 3552-7.
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  Despite the availability of safe and effective direct-acting antiviral drugs (DAAs), the vast majority of patients with chronic hepatitis C (HCV) in the USA remain untreated, in part due to lack of access to specialist providers.
• Aggarwal, A. (2014). Gastro-duodenal Artery (GDA) Pseudo-Aneurysm: Emerging Role of Endoscopic Ultrasound. The American Journal of Gastroenterology. doi:10.14309/00000434-201410002-01552
• Aggarwal, A. (2014). Mesenteric Thrombophlebitis: An Uncommon Complication of Diverticulitis. The American Journal of Gastroenterology. doi:10.14309/00000434-201410002-01344
• Kalra, A., Aggarwal, A., Kneeland, R., & Traverse, J. H. (2014). Percutaneous Coronary Intervention in Spontaneous Coronary Artery Dissection: Role of Intravascular Ultrasound. Cardiology and therapy, 3(1-2), 61-6.
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  Spontaneous coronary artery dissection (SCAD) is a rare, life-threatening condition that usually manifests as an acute myocardial infarction. Diagnosing SCAD with conventional coronary angiogram can be challenging, particularly if the true lumen is severely narrowed. Our case highlights the challenges in performing successful percutaneous coronary intervention (PCI) in patients with SCAD. Intravascular ultrasound can prove to be a pivotal tool in the diagnosis and successful management of such cases by establishing the anatomic site of dissection, and confirming stent placement in the true lumen following PCI.

Reviews

• Blohm, J. E., Panthula, M., Aggarwal, A., Swazo, R., Ashoka, A., & Ainapurapu, B. (2023. Fatal Disseminated Coccidioidomycosis in Cirrhosis: A Case Series(pp 707-709).
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  Coccidioidomycosis is endemic to the Southwest United States and Mexico. In this case series we describe 3 cases, occurring in the Southwest United States, of patients with disseminated coccidioidomycosis infection in cirrhosis, all with a miliary pattern present on chest imaging.