John T Cunningham

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Scholarly Contributions

Books

• Gavini, H., & Cunningham, J. T. (2015). Biliary stones. In Linda.S. Lee(Ed.), ERCP and EUS- A Case Based Approach. NewYork, NY: Springer.

Journals/Publications

• Draganov, P., Devonshire, D. A., & Cunningham, J. T. (2016). A new technique to assist in difficult bile duct cannulation at the time of endoscopic retrograde cholangiopancreatography. JSLS : Journal of the Society of Laparoendoscopic Surgeons / Society of Laparoendoscopic Surgeons, 9(2), 218-21.
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  At the time of endoscopic retrograde cholangiopancreatography, deep cannulation of the bile duct is a prerequisite to be able to provide endoscopic therapy. We describe a simple technique to assist in difficult bile duct cannulation.
• Perini, R. F., Uflacker, R., Cunningham, J. T., Selby, J. B., & Adams, D. (2016). Isolated right segmental hepatic duct injury following laparoscopic cholecystectomy. Cardiovascular and interventional radiology, 28(2), 185-95.
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  Laparoscopic cholecystectomy (LC) is the treatment of choice for gallstones. There is an increased incidence of bile duct injuries in LC compared with the open technique. Isolated right segmental hepatic duct injury (IRSHDI) represents a challenge not only for management but also for diagnosis. We present our experience in the management of IRSHDI, with long-term follow-up after treatment by a multidisciplinary approach.
• Porterfield, M., Zhao, p., Han, H., & Cunningham, J. T. (2014). Discrimination between adenocarcinoma and normal pancreatic ductal fluid by proteomic and glycomic analysis. J of Proteome Research, 13(2);395-407.
• Cao, Z., Maupin, K., Curnutte, B., Fallon, B., Feasley, C. L., Brouhard, E., Kwon, R., West, C. M., & Cunningham, J. T. (2014). Specific glycoforms of MUC5AC and endorepellin accurately distinguish mucinous from nonmucionous pancreatic cysts. Molecular & Cellular Proteomics, 12:2724-2734.
• Kasher, J. A., Corasanti, J. G., Tarnasky, P. R., McHenry, L., Fogel, E., & Cunningham, J. (2011). A multicenter analysis of safety and outcome of removal of a fully covered self-expandable metal stent during ERCP. Gastrointestinal endoscopy, 73(6), 1292-7.
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  Fully covered self-expandable metal stents (FCSEMSs) have been used for palliation of both malignant and benign biliary strictures. Limited data are available about safety and outcome of endoscopic removal of these stents.
• Rial, N. S., Gilchrist, K. B., Henderson, J. T., Bhattacharyya, A. K., Boyer, T. D., Nadir, A., & Cunningham, J. T. (2011). Endoscopic ultrasound with biopsy of omental mass for cholangiocarcinoma diagnosis in cirrhosis. World journal of gastrointestinal endoscopy, 3(6), 124-8.
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  In this report, a patient had a previous diagnosis of cholangiocarcinoma with an extended cholecystectomy. Three years later, he was evaluated for recurrent ascites. The patient had several large volume paracentesis, without evidence of malignant cells. Subsequently, endoscopic ultrasound (EUS) with fine needle aspiration (FNA) of both lymph and omental nodules was utilized. While the lymph nodes were negative for malignancy, the omental nodule was interrogated with multiple antibodies and was found to be positive for neoplasia. EUS with FNA can safely be used in patients with cirrhosis to spare the patient invasive evaluation such as exploratory laparotomy (ex-lap) for diagnosis and staging of cholangiocarcinoma.
• Rial, N. S., Henderson, J. T., Bhattacharyya, A. K., Nadir, A., & Cunningham, J. T. (2010). Use of endoscopic ultrasound for diagnosis of cholangiocarcinoma in auto-immune hepatitis. World journal of gastrointestinal endoscopy, 2(12), 404-7.
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  In this report, a patient was exposed to an herbal remedy for hypercholesterolemia. She became acutely jaundiced while taking the remedy and presented for medical care. Endoscopic ultrasound was utilized, and found a distal common bile duct mass. Endoscopic retrograde cholangiopancreatography guided bile duct biopsies revealed that the mass was cholangiocarcinoma (CCA). This case highlights a unique association between autoimmune hepatitis and CCA. It also highlights that EUS can be safely used in patients with cirrhosis to spare invasive evaluation such as exploratory laporotomy for diagnosis and staging of cholangiocarcinoma.
• Attasaranya, S., Cheon, Y. K., Vittal, H., Howell, D. A., Wakelin, D. E., Cunningham, J. T., Ajmere, N., Ste Marie, R. W., Bhattacharya, K., Gupta, K., Freeman, M. L., Sherman, S., McHenry, L., Watkins, J. L., Fogel, E. L., Schmidt, S., & Lehman, G. A. (2008). Large-diameter biliary orifice balloon dilation to aid in endoscopic bile duct stone removal: a multicenter series. Gastrointestinal endoscopy, 67(7), 1046-52.
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  The utility and safety of endoscopic biliary orifice balloon dilation (EBD) for bile duct stone removal (with use of large-diameter balloons) after biliary endoscopic sphincterotomy (BES) is currently not well established.
• Doldan, A., Chandramouli, A., Shanas, R., Bhattacharyya, A., Cunningham, J. T., Nelson, M. A., & Shi, J. (2008). Loss of the eukaryotic initiation factor 3f in pancreatic cancer. Molecular carcinogenesis, 47(3), 235-44.
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  Aberrant regulation of the translation initiation is known to contribute to tumorigenesis. eIF3 plays an important role in translation initiation. eIF3f is the p47 subunit of the eIF3 complex whose function in cancer is not clear. Initial studies from our group indicated that eIF3f expression is decreased in pancreatic cancer. Overexpression of eIF3f induces apoptosis in pancreatic cancer cells. The eIF3f gene is located at chromosome band region 11p15.4. Loss of 11p15.4 is a common event in many tumors including pancreatic cancer. In order to investigate the molecular mechanism of the decreased expression of eIF3f in pancreatic cancer, we performed loss of heterozygosity (LOH) analysis in 32 pancreatic cancer specimens using three microsatellite markers encompassing the eIF3f gene. We showed that the prevalence of LOH ranged from 71% to 93%. We also performed eIF3f gene copy number analysis using quantitative real time PCR to further confirm the specific allelic loss of eIF3f gene in pancreatic cancer. We demonstrated a statistically significant decrease of eIF3f gene copy number in pancreatic tumors compared with normal tissues with a tumor/normal ratio of 0.24. Furthermore, RNA in situ hybridization and tissue microarray immunohistochemistry analysis demonstrated that eIF3f expression is significantly decreased in human pancreatic adenocarcinoma tissues compared to normal pancreatic tissues. These data provides new insight into the understanding of the molecular pathogenesis of eIF3f during pancreatic tumorigenesis.
• Gigena, M., Villar, H. V., Knowles, N. G., Cunningham, J. T., Outwater, E. K., & Leon, L. R. (2007). Antegrade bowel intussusception after remote Whipple and Puestow procedures for treatment of pancreas divisum. World journal of gastroenterology, 13(44), 5954-6.
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  To date, antegrade intussusception involving a Roux-en-Y reconstruction has been reported only once. We report a case of acute bowel obstruction due to an intussusception involving two Roux-en-Y limbs in a 40-year-old woman with a history of chronic pancreatitis due to pancreas divisum. Four years preceding this event, the patient had undergone a Whipple procedure, and three years prior to that, a Puestow operation. The patient was successfully treated with bowel resection and a side-to-side anastomosis between the most distal aspect of the bowel and the most distal Roux-en-Y reconstruction, which preserved both Roux-en-Y reconstructions.
• Perini, R. F., Sadurski, R., Cotton, P. B., Patel, R. S., Hawes, R. H., & Cunningham, J. T. (2005). Post-sphincterotomy bleeding after the introduction of microprocessor-controlled electrosurgery: does the new technology make the difference?. Gastrointestinal endoscopy, 61(1), 53-7.
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  Bleeding as a complication of endoscopic sphincterotomy is influenced by several factors. The objective of this study was to compare rates of bleeding after sphincterotomy performed with two different electrosurgical current generators (Valleylab SSE2L and ERBE ICC200).
• Morelli, J., Mulcahy, H. E., Willner, I. R., Cunningham, J. T., & Draganov, P. (2003). Long-term outcomes for patients with post-liver transplant anastomotic biliary strictures treated by endoscopic stent placement. Gastrointestinal endoscopy, 58(3), 374-9.
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  Biliary stricture is one of the most common complications of liver transplantation. A number of treatment options are available, but a standard approach has not been established.
• Aithal, G. P., Chen, R. Y., Cunningham, J. T., Durkalski, V., Kim, E. Y., Patel, R. S., Wallace, M. B., Hawes, R. H., & Hoffman, B. J. (2002). Accuracy of EUS for detection of intraductal papillary mucinous tumor of the pancreas. Gastrointestinal endoscopy, 56(5), 701-7.
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  Patients with intraductal papillary mucinous tumors of the pancreas (IPMT) present with symptoms similar to those of chronic pancreatitis. This study assessed the accuracy of EUS for detection of IPMT and identified features that discriminate IPMT from chronic pancreatitis.
• Madhotra, R., Eloubeidi, M. A., Cunningham, J. T., Lewin, D., & Hoffman, B. (2002). Eosinophilic gastroenteritis masquerading as ampullary adenoma. Journal of clinical gastroenterology, 34(3), 240-2.
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  Eosinophilic gastroenteritis is a rare gastrointestinal disorder of undetermined etiology that is characterized by eosinophilic infiltration of the gut wall. The presenting symptoms depend on the site and depth of intestinal involvement and varies from nausea, vomiting, and abdominal pain to acute bowel obstruction. Pancreaticobiliary obstruction caused by eosinophilic gastroenteritis is rare. We report a 39-year-old man who presented with abdominal pain, vomiting, abnormal liver tests, and a duodenal mass on upper endoscopy. Blood tests showed peripheral eosinophilia. Abdominal computed tomography scan showed a suspected mass in ampullary region. At endoscopic retrograde cholangiopancreatography, both pancreatic and common bile duct were dilated with no obvious ductal strictures. Biopsies from the duodenal mass showed evidence of eosinophilic gastroenteritis. He was successfully treated with prednisone, and his liver test results returned to normal. In conclusion, this unusual case of eosinophilic gastroenteritis presented with duodenal mass that was masquerading as an ampullary adenoma causing pancreaticobiliary obstruction.