Bio

Clinical Focus


  • Pediatric Gastroenterology
  • Advance Endoscopy, ERCP, EUS
  • Pancreas

Academic Appointments


Professional Education


  • Board Certification: Pediatric Gastroenterology, American Board of Pediatrics (2011)
  • Fellowship: UCSF Graduate Division - Fellowships (2002) CA
  • Residency: Miami Children's Hospital (1999) FL
  • Residency: Maimonides Medical Center (1997) NY
  • Internship: UCLA David Geffen School Of Medicine Registrar (1996) CA
  • Medical Education: Universidad Central de Venezuela (1994)

Publications

All Publications


  • The Roles of EUS and ERCP in the Evaluation and Treatment of Chronic Pancreatitis in Children: A Position Paper from the NASPGHAN Pancreas Committee. Journal of pediatric gastroenterology and nutrition Liu, Q. Y., Gugig, R., Troendle, D. M., Bitton, S., Patel, N., Vitale, D. S., Abu-El-Haija, M., Husain, S. Z., Morinville, V. D. 2020

    Abstract

    INTRODUCTION: Pediatric chronic pancreatitis (CP) is increasingly diagnosed. Endoscopic methods (endoscopic ultrasound (EUS), endoscopic retrograde cholangiopancreatography (ERCP)) are useful tools to diagnose and manage CP. Pediatric knowledge and use of these modalities is limited and warrants dissemination.METHODS: Literature review of publications relating to use of ERCP and EUS for diagnosis and/or management of CP with special attention to studies involving 0-18 years old subjects was conducted with summaries generated. Recommendations were developed and voted upon by authors.RESULTS: Both EUS and ERCP can be used even in small children to assist in diagnosis of CP in cases where cross-sectional imaging is not sufficient to diagnose or characterize the disease. Children under 15?kg for EUS and 10?kg for ERCP can be technically challenging. These procedures should be done optimally by appropriately trained endoscopists and adult gastroenterology providers with appropriate experience treating children. EUS and ERCP-related risks both include perforation, bleeding and pancreatitis. EUS is the preferred diagnostic modality over ERCP due to lower complication rates overall. Both modalities can be used for management of CP-related fluid collections. ERCP has successfully been used to manage pancreatic duct stones.CONCLUSIONS: EUS and ERCP can be safely used to diagnose CP in pediatric patients and assist in management of CP-related complications. Procedure-related risks are similar to those seen in adults, with EUS having a safer risk profile overall. The recent increase in pediatric-trained specialists will improve access of these modalities for children.

    View details for DOI 10.1097/MPG.0000000000002664

    View details for PubMedID 32079975

  • The Roles of Endoscopic Ultrasound and Endoscopic Retrograde Cholangiopancreatography in the Evaluation and Treatment of Chronic Pancreatitis in Children: A Position Paper From the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition Pancreas Committee. Journal of pediatric gastroenterology and nutrition Liu, Q. Y., Gugig, R., Troendle, D. M., Bitton, S., Patel, N., Vitale, D. S., Abu-El-Haija, M., Husain, S. Z., Morinville, V. D. 2020; 70 (5): 681?93

    Abstract

    Pediatric chronic pancreatitis is increasingly diagnosed. Endoscopic methods [endoscopic ultrasound (EUS), endoscopic retrograde cholangiopancreatography (ERCP)] are useful tools to diagnose and manage chronic pancreatitis. Pediatric knowledge and use of these modalities is limited and warrants dissemination.Literature review of publications relating to use of ERCP and EUS for diagnosis and/or management of chronic pancreatitis with special attention to studies involving 0--18 years old subjects was conducted with summaries generated. Recommendations were developed and voted upon by authors.Both EUS and ERCP can be used even in small children to assist in diagnosis of chronic pancreatitis in cases where cross-sectional imaging is not sufficient to diagnose or characterize the disease. Children under 15?kg for EUS and 10?kg for ERCP can be technically challenging. These procedures should be done optimally by appropriately trained endoscopists and adult gastroenterology providers with appropriate experience treating children. EUS and ERCP-related risks both include perforation, bleeding and pancreatitis. EUS is the preferred diagnostic modality over ERCP because of lower complication rates overall. Both modalities can be used for management of chronic pancreatitis -related fluid collections. ERCP has successfully been used to manage pancreatic duct stones.EUS and ERCP can be safely used to diagnose chronic pancreatitis in pediatric patients and assist in management of chronic pancreatitis-related complications. Procedure-related risks are similar to those seen in adults, with EUS having a safer risk profile overall. The recent increase in pediatric-trained specialists will improve access of these modalities for children.

    View details for DOI 10.1097/MPG.0000000000002664

    View details for PubMedID 32332479

  • Out-of-pocket Cost Burden in Pediatric Inflammatory Bowel Disease: A Cross-sectional Cohort Analysis INFLAMMATORY BOWEL DISEASES Sin, A. T., Damman, J. L., Ziring, D. A., Gleghorn, E. E., Garcia-Careaga, M. G., Gugig, R. R., Hunter, A. K., Burgis, J. C., Bass, D. M., Park, K. T. 2015; 21 (6): 1368-1377

    Abstract

    Pediatric inflammatory bowel disease (IBD), consisting of Crohn's disease (CD) and ulcerative colitis (UC), can result in significant morbidity requiring frequent health care utilization. Although it is known that the overall financial impact of pediatric IBD is significant, the direct out-of-pocket (OOP) cost burden on the parents of children with IBD has not been explored. We hypothesized that affected children with a more relapsing disease course and families in lower income strata, ineligible for need-based assistance programs, disparately absorb ongoing financial stress.We completed a cross-sectional analysis among parents of children with IBD residing in California using an online HIPAA-secure Qualtrics survey. Multicenter recruitment occurred between December 4, 2013 and September 18, 2014 at the point-of-care from site investigators, informational flyers distributed at regional CCFA conferences, and social media campaigns equally targeting Northern, Central, and Southern California. IBD-, patient-, and family-specific information were collected from the parents of pediatric patients with IBD patients younger than 18 years of age at time of study, carry a confirmed diagnosis of CD or UC, reside in and receive pediatric gastroenterology care in California, and do not have other chronic diseases requiring ongoing medical care.We collected 150 unique surveys from parents of children with IBD (67 CD; 83 UC). The median patient age was 14 years for both CD and UC, with an overall 3.7 years (SD 2.8 yr) difference between survey completion and time of IBD diagnosis. Annually, 63.6%, 28.6%, and 5.3% of families had an OOP cost burden >$500, >$1000, and >5000, respectively. Approximately one-third (36.0%) of patients had emergency department (ED) visits over the past year, with 59.2% of these patients spending >$500 on emergency department copays, including 11.1% who spent >$5000. Although 43.3% contributed <$500 on procedure and test costs, 20.0% spent >$2000 in the past year. Families with household income between $50,000 and $100,000 had a statistically significant probability (80.6%) of higher annual OOP costs than families with lower income <$50,000 (20.0%; P < 0.0001) or higher income >$100,000 (64.6%; P < 0.05). Multivariate analysis revealed that clinical variables associated with uncontrolled IBD states correlated to higher OOP cost burden. Annual OOP costs were more likely to be >$500 among patients who had increased spending on procedures and tests (odds ratio [OR], 5.63; 95% confidence interval [CI], 2.73-11.63), prednisone course required over the past year (OR, 3.19; 95% CI, 1.02-9.92), at least 1 emergency department visit for IBD symptoms (OR, 2.84; 95% CI, 1.33-6.06), at least 4 or more outpatient primary medical doctor visits for IBD symptoms (OR, 2.82; 95% CI, 1.40-5.68), and history of 4 or more lifetime hospitalizations for acute IBD care (OR, 2.60; 95% CI, 1.13-5.96).Previously undocumented, a high proportion of pediatric IBD families incur substantial OOP cost burden. Patients who are frequently in relapsing and uncontrolled IBD states require more acute care services and sustain higher OOP cost burden. Lower middle income parents of children with IBD ineligible for need-based assistance may be particularly at risk for financial stress from OOP costs related to ongoing medical care.

    View details for DOI 10.1097/MIB.0000000000000374

    View details for Web of Science ID 000355315800020

    View details for PubMedID 25839776

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