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Shah SL, Dunbar K. Revisiting Proton Pump Inhibitors as Chemoprophylaxis Against the Progression of Barrett's Esophagus. Curr Gastroenterol Rep 2023; 25:374-379. [PMID: 37940812 DOI: 10.1007/s11894-023-00905-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/24/2023] [Indexed: 11/10/2023]
Abstract
PURPOSE OF REVIEW Barrett's esophagus (BE) is associated with chronic gastroesophageal reflux disease and is a known precursor to esophageal adenocarcinoma. While endoscopic surveillance strategies and the role for endoscopic eradication therapy have been well established, there has been much interest in identifying chemopreventive agents to disrupt or halt the metaplasia-dysplasia-carcinoma sequence in patients with BE. RECENT FINDINGS No pharmacological agent has held more hope in reducing the risk of neoplastic progression in BE than proton pump inhibitors (PPIs). However, data supporting PPIs for chemoprevention have largely been from observational cohort and case-control studies with mixed results. In this review, we revisit the literature and highlight the role of PPIs in patients with BE as it pertains to chemoprophylaxis against the progression of BE to dysplasia and esophageal adenocarcinoma.
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Affiliation(s)
- Shawn L Shah
- Division of Gastroenterology and Hepatology, Department of Medicine, Dallas VA Medical Center and University of Texas Southwestern Medical Center, Dallas, TX, USA.
| | - Kerry Dunbar
- Division of Gastroenterology and Hepatology, Department of Medicine, Dallas VA Medical Center and University of Texas Southwestern Medical Center, Dallas, TX, USA
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2
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Machicado JD, Napoleon B, Akshintala V, Bazarbashi AN, Bilal M, Corral JE, Dugum M, Han S, Hussain FS, Johnson AM, Jovani M, Kolb JM, Leonor P, Lee PJ, Mulki R, Shah H, Singh H, Sánchez-Luna SA, Shah SL, Singla A, Vargas EJ, Tielleman T, Nikahd M, Fry M, Culp S, Krishna SG. Structured training program on confocal laser endomicroscopy for pancreatic cystic lesions: a multicenter prospective study among early-career endosonographers (with video). Gastrointest Endosc 2023; 98:953-964. [PMID: 37473969 PMCID: PMC10771632 DOI: 10.1016/j.gie.2023.07.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 06/08/2023] [Accepted: 07/17/2023] [Indexed: 07/22/2023]
Abstract
BACKGROUND AND AIMS Data on how to teach endosonographers needle-based confocal laser endomicroscopy (nCLE)-guided histologic diagnosis of pancreatic cystic lesions (PCLs) are limited. Hence, we developed and tested a structured educational program to train early-career endosonographers in nCLE-guided diagnosis of PCLs. METHODS Twenty-one early-career nCLE-naïve endosonographers watched a teaching module outlining nCLE criteria for diagnosing PCLs. Participants then reviewed 80 high-yield nCLE videos, recorded diagnoses, and received expert feedback (phase 1). Observers were then randomized to a refresher feedback session or self-learning at 4 weeks. Eight weeks after training, participants independently assessed the same 80 nCLE videos without feedback and provided histologic predictions (phase 2). Diagnostic performance of nCLE to differentiate mucinous versus nonmucinous PCLs and to diagnose specific subtypes were analyzed using histopathology as the criterion standard. Learning curves were determined using cumulative sum analysis. RESULTS Accuracy and diagnostic confidence for differentiating mucinous versus nonmucinous PCLs improved as endosonographers progressed through nCLE videos in phase 1 (P < .001). Similar trends were observed with the diagnosis of PCL subtypes. Most participants achieved competency interpreting nCLE, requiring a median of 38 assessments (range, 9-67). During phase 2, participants independently differentiated PCLs with high accuracy (89%), high confidence (83%), and substantial interobserver agreement (κ = .63). Accuracy for nCLE-guided PCL subtype diagnoses ranged from 82% to 96%. The learned nCLE skills did not deteriorate at 8 weeks and were not impacted by a refresher session. CONCLUSIONS We developed a practical, effective, and durable educational intervention to train early-career endosonographers in nCLE-guided diagnosis of PCLs.
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Affiliation(s)
- Jorge D Machicado
- Division of Gastroenterology and Hepatology, University of Michigan, Ann Arbor, Michigan, USA
| | - Bertrand Napoleon
- Gastroenterology Department, Hopital Privé Jean Mermoz, Ramsay Generale de Sante, Lyon, France
| | - Venkata Akshintala
- Division of Gastroenterology and Hepatology, Johns Hopkins Medicine, Baltimore, Maryland, USA
| | | | - Mohammad Bilal
- Division of Gastroenterology, Hepatology, and Nutrition, University of Minnesota, Minneapolis, Minnesota, USA
| | - Juan E Corral
- Division of Gastroenterology and Hepatology, Presbyterian Hospital, Albuquerque, New Mexico, USA
| | | | - Samuel Han
- Division of Gastroenterology, Hepatology, and Nutrition, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | | | - Alyson M Johnson
- Division of Gastroenterology, Duke University, Durham, North Carolina, USA
| | - Manol Jovani
- Division of Gastroenterology, Maimonides Medical Center, SUNY Downstate University, Brooklyn, New York, USA
| | - Jennifer M Kolb
- Division of Digestive Diseases, VA Greater Los Angeles Healthcare System, Los Angeles, California, USA
| | - Paul Leonor
- Division of Gastroenterology and Hepatology, Loma Linda University, Loma Linda, California, USA
| | - Peter J Lee
- Division of Gastroenterology, Hepatology, and Nutrition, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Ramzi Mulki
- Basil I. Hirschowitz Endoscopic Center of Excellence, Division of Gastroenterology & Hepatology, Department of Internal Medicine, The University of Alabama at Birmingham Heersink School of Medicine, Birmingham, Alabama, USA
| | - Hamza Shah
- Division of Gastroenterology, Hepatology, and Nutrition, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Harkirat Singh
- Division of Gastroenterology, Hepatology, and Nutrition, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Sergio A Sánchez-Luna
- Basil I. Hirschowitz Endoscopic Center of Excellence, Division of Gastroenterology & Hepatology, Department of Internal Medicine, The University of Alabama at Birmingham Heersink School of Medicine, Birmingham, Alabama, USA
| | - Shawn L Shah
- Division of Digestive and Liver Diseases, Veterans Affairs North Texas Health Care System, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Anand Singla
- Division of Gastroenterology, University of Washington, Seattle, Washington, USA
| | - Eric J Vargas
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA
| | - Thomas Tielleman
- Division of Digestive and Liver Diseases, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Melica Nikahd
- Department of Biomedical Informatics, College of Medicine, The Ohio State University, Columbus, Ohio, USA
| | - Megan Fry
- Division of Gastroenterology, Hepatology, and Nutrition, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Stacey Culp
- Department of Biomedical Informatics, College of Medicine, The Ohio State University, Columbus, Ohio, USA
| | - Somashekar G Krishna
- Division of Gastroenterology, Hepatology, and Nutrition, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
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Zaki TA, Mbah M, Mir M, Sims RD, Amin A, Shah SL. Colitis Cystica Profunda: A Rare Mimicker of Colorectal Neoplasia. Dig Dis Sci 2022; 67:2693-2695. [PMID: 35616804 DOI: 10.1007/s10620-022-07544-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Accepted: 04/26/2022] [Indexed: 12/09/2022]
Affiliation(s)
- Timothy A Zaki
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA.
| | - Mireille Mbah
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Mariam Mir
- Department of Pathology, Dallas VA Medical Center - VA North Texas Healthcare System, Dallas, TX, USA
| | - Robert D Sims
- Department of Radiology, Dallas VA Medical Center - VA North Texas Healthcare System, Dallas, TX, USA
| | - Amin Amin
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Shawn L Shah
- Division of Gastroenterology and Hepatology, Dallas VA Medical Center - VA North Texas Healthcare System and University of Texas Southwestern Medical Center, Dallas, TX, USA
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Mehta A, Hajifathalian K, Shah SL, Mahadev S, Sampath K, Carr-Locke DL, Sharaiha RZ. Quality of Life, Mental Health, and Weight Loss Outcomes Following Endoscopic Sleeve Gastroplasty. J Gastrointest Surg 2022; 26:469-471. [PMID: 34506034 DOI: 10.1007/s11605-021-05137-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Accepted: 08/21/2021] [Indexed: 01/31/2023]
Affiliation(s)
- Amit Mehta
- Division of Gastroenterology and Hepatology, New York-Presbyterian Hospital-Weill Cornell Medical Center, New York, NY, 10021, USA
| | - Kaveh Hajifathalian
- Division of Gastroenterology and Hepatology, New York-Presbyterian Hospital-Weill Cornell Medical Center, New York, NY, 10021, USA
| | - Shawn L Shah
- Division of Gastroenterology and Hepatology, New York-Presbyterian Hospital-Weill Cornell Medical Center, New York, NY, 10021, USA
| | - SriHari Mahadev
- Division of Gastroenterology and Hepatology, New York-Presbyterian Hospital-Weill Cornell Medical Center, New York, NY, 10021, USA
| | - Kartik Sampath
- Division of Gastroenterology and Hepatology, New York-Presbyterian Hospital-Weill Cornell Medical Center, New York, NY, 10021, USA
| | - David L Carr-Locke
- Division of Gastroenterology and Hepatology, New York-Presbyterian Hospital-Weill Cornell Medical Center, New York, NY, 10021, USA
| | - Reem Z Sharaiha
- Division of Gastroenterology and Hepatology, New York-Presbyterian Hospital-Weill Cornell Medical Center, New York, NY, 10021, USA.
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Tyberg A, Napoleon B, Robles-Medranda C, Shah JN, Bories E, Kumta NA, Yague AS, Vazquez-Sequeiros E, Lakhtakia S, El Chafic AH, Shah SL, Sameera S, Tawadros A, Ardengh JC, Kedia P, Gaidhane M, Giovannini M, Kahaleh M. Hepaticogastrostomy versus choledochoduodenostomy: An international multicenter study on their long-term patency. Endosc Ultrasound 2021; 11:38-43. [PMID: 34494590 PMCID: PMC8887039 DOI: 10.4103/eus-d-21-00006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Background and Objectives: EUS-guided biliary drainage (EUS-BD) offers minimally invasive decompression when conventional endoscopic retrograde cholangiopancreatography fails. Stents can be placed from the intrahepatic ducts into the stomach (hepaticogastrostomy [HG]) or from the extrahepatic bile duct into the small intestine (choledochoduodenostomy [CCD]). Long-term patency of these stents is unknown. In this study, we aim to compare long-term patency of CCD versus HG. Methods: Consecutive patients from 12 centers were included in a registry over 14 years. Demographics, procedure info, adverse events, and follow-up data were collected. Student's t-test, Chi–square, and logistic regression analyses were conducted. Only patients with at least 6-month follow-up or who died within 6-month postprocedure were included. Results: One-hundred and eighty-two patients were included (93% male; mean age: 70; HG n = 95, CCD n = 87). No significant difference in indication, diagnosis, dissection instrument, or stent type was seen between the two groups. Technical success was 92% in both groups. Clinical success was achieved in 75/87 (86%) in the HG group and 80/80 (100%) in the CCD group. A trend toward higher adverse events was seen in the CCD group. A total of 25 patients out of 87 needed stent revision in the HG group (success rate 71%), while eight out of 80 were revised in the CCD group (success rate 90%). Chi square shows CCD success higher than HG (90% vs. 71%, P = 0.010). After adjusting for diagnosis, jaundice or cholangitis presentation, instrument used for dissection, and gender, CCD was 4.5 times more likely than HG to achieve longer stent patency or manage obstruction (odds ratio 4.5; 95% 1.1548–17.6500, P = 0.0302). Conclusion: CCD is associated with superior long-term patency than HG but with a trend toward higher adverse events. This is particularly important in patients with increased survival. Additional studies are required before recommending a change in practice.
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Affiliation(s)
- Amy Tyberg
- Rutgers Robert Wood Johnson Medical Hospital, New Brunswick, New Jersey, USA
| | | | | | - Janak N Shah
- Ochsner Medical Center, New Orleans, Lousiana, USA
| | - Erwan Bories
- Ochsner Medical Center, New Orleans, Lousiana, USA
| | | | | | | | | | | | | | - Sohini Sameera
- Rutgers Robert Wood Johnson Medical Hospital, New Brunswick, New Jersey, USA
| | - Augustine Tawadros
- Rutgers Robert Wood Johnson Medical Hospital, New Brunswick, New Jersey, USA
| | | | | | - Monica Gaidhane
- Rutgers Robert Wood Johnson Medical Hospital, New Brunswick, New Jersey, USA
| | - Marc Giovannini
- Department of Endoscopy, Institut Paoli-Calmettes, Marseille, France
| | - Michel Kahaleh
- Rutgers Robert Wood Johnson Medical Hospital, New Brunswick, New Jersey, USA
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6
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Shah SL, Barie PS, Bronstein ME, Chang PH, Gibson CJ, Houng AP, Kelly AE, Lee C, Lodescar RJ, Mahadev S, Shou J, Smith KE, Villegas CV, Winchell RJ, Narayan M. Burns and Fatal Acute Lung Injury Ignited by a Smartphone Charger during Non-Invasive Ventilation for COVID-19. Surg Infect (Larchmt) 2021; 22:1097-1098. [PMID: 34107747 DOI: 10.1089/sur.2021.121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Shawn L Shah
- Division of Gastroenterology and Hepatology, Burns, Acute and Critical Care, Department of Surgery, Weill Cornell Medicine, New York, New York, USA
| | - Philip S Barie
- Division of Trauma, Burns, Acute and Critical Care, Department of Surgery, Weill Cornell Medicine, New York, New York, USA.,Division of Medical Ethics, Department of Medicine, Burns, Acute and Critical Care, Department of Surgery, Weill Cornell Medicine, New York, New York, USA
| | - Matthew E Bronstein
- Division of Trauma, Burns, Acute and Critical Care, Department of Surgery, Weill Cornell Medicine, New York, New York, USA
| | - Philip H Chang
- Division of Trauma, Burns, Acute and Critical Care, Department of Surgery, Weill Cornell Medicine, New York, New York, USA
| | - Cameron J Gibson
- Division of Trauma, Burns, Acute and Critical Care, Department of Surgery, Weill Cornell Medicine, New York, New York, USA
| | - Abraham P Houng
- Division of Trauma, Burns, Acute and Critical Care, Department of Surgery, Weill Cornell Medicine, New York, New York, USA
| | - Anton E Kelly
- Division of Trauma, Burns, Acute and Critical Care, Department of Surgery, Weill Cornell Medicine, New York, New York, USA
| | - Christina Lee
- Division of Trauma, Burns, Acute and Critical Care, Department of Surgery, Weill Cornell Medicine, New York, New York, USA
| | - Rachelle J Lodescar
- Division of Medical Ethics, Department of Medicine, Burns, Acute and Critical Care, Department of Surgery, Weill Cornell Medicine, New York, New York, USA
| | - Srihari Mahadev
- Division of Gastroenterology and Hepatology, Burns, Acute and Critical Care, Department of Surgery, Weill Cornell Medicine, New York, New York, USA
| | - Jian Shou
- Division of Medical Ethics, Department of Medicine, Burns, Acute and Critical Care, Department of Surgery, Weill Cornell Medicine, New York, New York, USA
| | - Kira E Smith
- Division of Trauma, Burns, Acute and Critical Care, Department of Surgery, Weill Cornell Medicine, New York, New York, USA
| | - Cassandra V Villegas
- Division of Trauma, Burns, Acute and Critical Care, Department of Surgery, Weill Cornell Medicine, New York, New York, USA
| | - Robert J Winchell
- Division of Trauma, Burns, Acute and Critical Care, Department of Surgery, Weill Cornell Medicine, New York, New York, USA
| | - Mayur Narayan
- Division of Trauma, Burns, Acute and Critical Care, Department of Surgery, Weill Cornell Medicine, New York, New York, USA
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Dawod Q, Issa D, Shah SL, Dawod S, Sharaiha RZ. EUS-guided stent placement for afferent limb and gastrojejunal obstruction in a patient with pancreatic cancer. VideoGIE 2021; 6:257-259. [PMID: 34141966 PMCID: PMC8186170 DOI: 10.1016/j.vgie.2021.02.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Video 1EUS-guided stent placement for afferent limb and gastrojejunal obstruction in a patient with pancreatic cancer.
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Affiliation(s)
- Qais Dawod
- Division of Gastroenterology & Hepatology, NewYork-Presbyterian Hospital and Weill Cornell Medical Center, New York, New York
| | - Danny Issa
- Division of Gastroenterology & Hepatology, NewYork-Presbyterian Hospital and Weill Cornell Medical Center, New York, New York
| | - Shawn L Shah
- Division of Gastroenterology & Hepatology, NewYork-Presbyterian Hospital and Weill Cornell Medical Center, New York, New York
| | - Sanad Dawod
- Division of Gastroenterology & Hepatology, NewYork-Presbyterian Hospital and Weill Cornell Medical Center, New York, New York
| | - Reem Z Sharaiha
- Division of Gastroenterology & Hepatology, NewYork-Presbyterian Hospital and Weill Cornell Medical Center, New York, New York
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Novikov AA, Fieber JH, Saumoy M, Rosenblatt R, Mekelburg SAC, Shah SL, Crawford CV. ERCP improves mortality in acute biliary pancreatitis without cholangitis. Endosc Int Open 2021; 9:E927-E933. [PMID: 34079880 PMCID: PMC8159624 DOI: 10.1055/a-1320-0041] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Accepted: 09/23/2020] [Indexed: 12/17/2022] Open
Abstract
Background and study aims Acute pancreatitis (AP) is an increasingly common indication for hospitalization in the United States. The necessity for endoscopic retrograde cholangiopancreatography (ERCP) and the timing of ERCP in acute gallstone-related pancreatitis without cholangitis (AGPNC) is controversial. The aim of this study was to evaluate the association of ERCP and its performance during admission with mortality and length of stay (LOS) in patients with AGPNC. Patients and methods We queried the Nationwide Inpatient Sample (NIS) from 2004 to 2014 to identify all patients with admissions for gallstone AP. We excluded patients with chronic pancreatitis or concurrent cholangitis, and those who were transferred from elsewhere for treatment. Our primary outcome measure was inpatient mortality. Our secondary outcome measure was hospital length of stay (LOS). Results We identified 491,011 records eligible for analysis. Of the patients, 30.6 % (150,101) had AGPNC. There were 1.34 deaths per 100 admissions in patients with AGPNC. The average LOS was 5.88 (± 6.38) days with a median stay of 4 days (range, 3-7). When adjusted for age, Elixhauser Comorbidity Index, and severe pancreatitis, patients with ERCP during admission were 43 % less likely to die. ERCP performed between Days 3 and 9 of hospitalization resulted in a significant mortality benefit. Among those who had ERCP, a shorter wait time for ERCP was associated with a shorter LOS after adjustment for demographics and severity of illness. Conclusion ERCP performed during inpatient admission for AGPNC was associated with decreased mortality. These data support early ERCP in patients with acute gallstone pancreatitis without cholangitis.
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Affiliation(s)
- Aleksey A. Novikov
- Department of Gastroenterology, Doylestown Hospital, Doylestown, Pennsylvania, United States
| | - Jennifer H. Fieber
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Department of Surgery, Hospital of the University of Pennsylvania,
Philadelphia, Pennsylvania, United States
| | - Monica Saumoy
- Division of Gastroenterology and Hepatology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, United States
| | - Russell Rosenblatt
- Division of Gastroenterology and Hepatology, Weill Cornell Medical College, New York, New York, United States
| | | | - Shawn L. Shah
- Division of Gastroenterology and Hepatology, Weill Cornell Medical College, New York, New York, United States
| | - Carl V. Crawford
- Division of Gastroenterology and Hepatology, Weill Cornell Medical College, New York, New York, United States
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Mehta A, Shah SL, Mahadev S. Endoscopic stricturotomy for a refractory complex esophageal stricture. Endoscopy 2021; 53:E181-E182. [PMID: 32877938 DOI: 10.1055/a-1230-3008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Affiliation(s)
- Amit Mehta
- New York Presbyterian Hospital/Weill Cornell Medical Center, New York, New York, USA
| | - Shawn L Shah
- New York Presbyterian Hospital/Weill Cornell Medical Center, New York, New York, USA
| | - Srihari Mahadev
- New York Presbyterian Hospital/Weill Cornell Medical Center, New York, New York, USA
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Hajifathalian K, Mehta A, Ang B, Skaf D, Shah SL, Saumoy M, Dawod Q, Dawod E, Shukla A, Aronne L, Brown RS, Cohen DE, Dannenberg AJ, Fortune B, Kumar S, Sharaiha RZ. Improvement in insulin resistance and estimated hepatic steatosis and fibrosis after endoscopic sleeve gastroplasty. Gastrointest Endosc 2021; 93:1110-1118. [PMID: 32861753 DOI: 10.1016/j.gie.2020.08.023] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Accepted: 08/23/2020] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS Nonalcoholic fatty liver disease (NAFLD) is the most common cause of chronic liver disease in the United States and is closely associated with obesity and insulin resistance (IR). Weight loss is the best treatment for NAFLD. Endoscopic sleeve gastroplasty (ESG) is a promising endoscopic procedure for treatment of obesity. Our aim is to evaluate the change in IR and estimated hepatic steatosis and fibrosis after ESG. METHODS One hundred eighteen patients with obesity and NAFLD underwent ESG and were followed for 2 years. Weight loss was evaluated as % total body weight loss. IR was evaluated using the homeostasis model assessment of insulin resistance (HOMA-IR). The previously validated hepatic steatosis index and NAFLD fibrosis score were used to estimate hepatic steatosis and risk of fibrosis. RESULTS Patients' mean body mass index was 40 ± 7 kg/m2 at baseline. Eighty-four percent of patients completed 2 years of follow-up. At 2 years, the mean total body weight loss was 15.5% (95% confidence interval, 13.3%-17.8%). Patients' HOMA-IR improved significantly from 6.7 ± 11 to 3.0 ± 1.6 after only 1 week from ESG (P = .019) with continued improvement up to 2 years (P = .03). Patients' hepatic steatosis index score improved significantly, decreasing by 4 points per year (P for trend, <.001). Patients' NAFLD fibrosis score improved significantly, decreasing by 0.3 point per year (P for trend, .034). Twenty-four patients (20%) improved their risk of hepatic fibrosis from F3-F4 or indeterminate to F0-F2, whereas only 1 patient (1%) experienced an increase in the estimated risk of fibrosis (P = .02). CONCLUSIONS Our results suggest a significant and sustained improvement in estimated hepatic steatosis and fibrosis after ESG in patients with NAFLD. Importantly, we showed an early and weight-independent improvement in insulin resistance, which lasted for 2 years after the procedure.
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Affiliation(s)
- Kaveh Hajifathalian
- Division of Gastroenterology and Hepatology, Weill Cornell Medicine, New York-Presbyterian Hospital, New York, New York
| | - Amit Mehta
- Division of Gastroenterology and Hepatology, Weill Cornell Medicine, New York-Presbyterian Hospital, New York, New York
| | - Bryan Ang
- Joan & Sanford I. Weill Medical College of Cornell University, New York, New York
| | - Daniel Skaf
- Joan & Sanford I. Weill Medical College of Cornell University, New York, New York
| | - Shawn L Shah
- Division of Gastroenterology and Hepatology, Weill Cornell Medicine, New York-Presbyterian Hospital, New York, New York
| | - Monica Saumoy
- Gastroenterology and Hepatology Department, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Qais Dawod
- Division of Gastroenterology and Hepatology, Weill Cornell Medicine, New York-Presbyterian Hospital, New York, New York
| | - Enad Dawod
- Joan & Sanford I. Weill Medical College of Cornell University, New York, New York
| | - Alpana Shukla
- Division of Endocrinology Diabetes and Metabolism, Weill Cornell Medicine, New York-Presbyterian Hospital, New York, New York
| | - Louis Aronne
- Division of Endocrinology Diabetes and Metabolism, Weill Cornell Medicine, New York-Presbyterian Hospital, New York, New York
| | - Robert S Brown
- Division of Gastroenterology and Hepatology, Weill Cornell Medicine, New York-Presbyterian Hospital, New York, New York
| | - David E Cohen
- Division of Gastroenterology and Hepatology, Weill Cornell Medicine, New York-Presbyterian Hospital, New York, New York
| | - Andrew J Dannenberg
- Department of Medicine, Weill Cornell Medicine, New York-Presbyterian Hospital, New York, New York, USA
| | - Brett Fortune
- Division of Gastroenterology and Hepatology, Weill Cornell Medicine, New York-Presbyterian Hospital, New York, New York
| | - Sonal Kumar
- Division of Gastroenterology and Hepatology, Weill Cornell Medicine, New York-Presbyterian Hospital, New York, New York
| | - Reem Z Sharaiha
- Division of Gastroenterology and Hepatology, Weill Cornell Medicine, New York-Presbyterian Hospital, New York, New York
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Shah SL, Janisch NH, Crowell M, Lacy BE. Patients With Irritable Bowel Syndrome Are Willing to Take Substantial Medication Risks for Symptom Relief. Clin Gastroenterol Hepatol 2021; 19:80-86. [PMID: 32289536 DOI: 10.1016/j.cgh.2020.04.003] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Revised: 03/26/2020] [Accepted: 04/03/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Irritable bowel syndrome (IBS) is a common chronic functional bowel disorder for which patients take significant risks to ameliorate symptoms. Unfortunately, there is no cure for IBS. We assessed the willingness of patients with IBS to take medication risks and the costs they would pay to improve symptoms. METHODS We mailed a survey on medication risk to patients with IBS who met the Rome IV criteria. The survey collected data on patient demographics, symptoms, medication use, prior medication-averse events, and pain catastrophization. A standard gamble evaluated respondents' willingness to take medication risks, and a willingness-to-pay set of questions quantified maximal spending on a hypothetical medication to treat IBS. RESULTS Among respondents (n = 215; 81.8% female; mean age, 57 y) the average duration of IBS symptoms was 17.7 years. Patients whose predominant symptom was severe diarrhea (diarrhea-predominant IBS) reported accepting a mean 10.2% ± 15.7% risk of sudden death for a 99% chance of cure. Pain catastrophizing scale scores were not associated with an increased likelihood of taking medication risks. Patients with IBS would be willing to pay an average amount of $73 per month (if annual income was <$75,000) and $197 per month (if annual income was >$75,000) for a medication that would resolve their pain. CONCLUSIONS In a survey of 215 patients with IBS, we found that patients with diarrhea-predominant IBS are willing to take extraordinary risks to improve their symptoms, whereas patients with IBS and pain catastrophization are not. Clinician understanding of patients' willingness to take medication risks might help them guide their patients through complex therapeutic options.
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Affiliation(s)
- Shawn L Shah
- Division of Gastroenterology and Hepatology, New York-Presbyterian Hospital, Weill Cornell Medical Center, New York, New York.
| | - Nigeen H Janisch
- Division of Gastroenterology and Hepatology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
| | - Michael Crowell
- Division of Gastroenterology and Hepatology, Mayo Clinic, Phoenix, Arizona
| | - Brian E Lacy
- Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, Florida
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Martin TA, Wan DW, Hajifathalian K, Tewani S, Shah SL, Mehta A, Kaplan A, Ghosh G, Choi AJ, Krisko TI, Fortune BE, Crawford CV, Sharaiha RZ. Gastrointestinal Bleeding in Patients With Coronavirus Disease 2019: A Matched Case-Control Study. Am J Gastroenterol 2020; 115:1609-1616. [PMID: 32796176 PMCID: PMC7446989 DOI: 10.14309/ajg.0000000000000805] [Citation(s) in RCA: 69] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
INTRODUCTION Although current literature has addressed gastrointestinal presentations including nausea, vomiting, diarrhea, abnormal liver chemistries, and hyperlipasemia as possible coronavirus disease 2019 (COVID-19) manifestations, the risk and type of gastrointestinal bleeding (GIB) in this population is not well characterized. METHODS This is a matched case-control (1:2) study with 41 cases of GIB (31 upper and 10 lower) in patients with COVID-19 and 82 matched controls of patients with COVID-19 without GIB. The primary objective was to characterize bleeding etiologies, and our secondary aim was to discuss outcomes and therapeutic approaches. RESULTS There was no difference in the presenting symptoms of the cases and controls, and no difference in severity of COVID-19 manifestations (P > 0.05) was observed. Ten (32%) patients with upper GIB underwent esophagogastroduodenoscopy and 5 (50%) patients with lower GIBs underwent flexible sigmoidoscopy or colonoscopy. The most common upper and lower GIB etiologies were gastric or duodenal ulcers (80%) and rectal ulcers related to rectal tubes (60%), respectively. Four of the esophagogastroduodenoscopies resulted in therapeutic interventions, and the 3 patients with rectal ulcers were referred to colorectal surgery for rectal packing. Successful hemostasis was achieved in all 7 cases that required interventions. Transfusion requirements between patients who underwent endoscopic therapy and those who were conservatively managed were not significantly different. Anticoagulation and rectal tube usage trended toward being a risk factor for GIB, although it did not reach statistical significance. DISCUSSION In COVID-19 patients with GIB, compared with matched controls of COVID-19 patients without GIB, there seemed to be no difference in initial presenting symptoms. Of those with upper and lower GIB, the most common etiology was peptic ulcer disease and rectal ulcers from rectal tubes, respectively. Conservative management seems to be a reasonable initial approach in managing these complex cases, but larger studies are needed to guide management.
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Affiliation(s)
- Tracey A. Martin
- Division of Gastroenterology and Hepatology, Weill Cornell Medicine, New York-Presbyterian Hospital, New York, New York
| | - David W. Wan
- Division of Gastroenterology and Hepatology, Weill Cornell Medicine, New York-Presbyterian Hospital, New York, New York
| | - Kaveh Hajifathalian
- Division of Gastroenterology and Hepatology, Weill Cornell Medicine, New York-Presbyterian Hospital, New York, New York
| | - Sunena Tewani
- Division of Hospital Medicine, Weill Cornell Medicine, New York-Presbyterian Hospital, New York, New York
| | - Shawn L. Shah
- Division of Gastroenterology and Hepatology, Weill Cornell Medicine, New York-Presbyterian Hospital, New York, New York
| | - Amit Mehta
- Division of Gastroenterology and Hepatology, Weill Cornell Medicine, New York-Presbyterian Hospital, New York, New York
| | - Alyson Kaplan
- Division of Gastroenterology and Hepatology, Weill Cornell Medicine, New York-Presbyterian Hospital, New York, New York
| | - Gaurav Ghosh
- Division of Gastroenterology and Hepatology, Weill Cornell Medicine, New York-Presbyterian Hospital, New York, New York
| | - Anthony J. Choi
- Division of Gastroenterology and Hepatology, Weill Cornell Medicine, New York-Presbyterian Hospital, New York, New York
| | - Tibor I. Krisko
- Division of Gastroenterology and Hepatology, Weill Cornell Medicine, New York-Presbyterian Hospital, New York, New York
| | - Brett E. Fortune
- Division of Gastroenterology and Hepatology, Weill Cornell Medicine, New York-Presbyterian Hospital, New York, New York
| | - Carl V. Crawford
- Division of Gastroenterology and Hepatology, Weill Cornell Medicine, New York-Presbyterian Hospital, New York, New York
| | - Reem Z. Sharaiha
- Division of Gastroenterology and Hepatology, Weill Cornell Medicine, New York-Presbyterian Hospital, New York, New York
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13
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Affiliation(s)
- Shawn L Shah
- Division of Gastroenterology and Hepatology, NewYork-Presbyterian Hospital and Weill Cornell Medical Center, New York, New York
| | - Qais Dawod
- Division of Gastroenterology and Hepatology, NewYork-Presbyterian Hospital and Weill Cornell Medical Center, New York, New York
| | - Sonal Kumar
- Division of Gastroenterology and Hepatology, NewYork-Presbyterian Hospital and Weill Cornell Medical Center, New York, New York
| | - Brett Fortune
- Division of Gastroenterology and Hepatology, NewYork-Presbyterian Hospital and Weill Cornell Medical Center, New York, New York
| | - Reem Z Sharaiha
- Division of Gastroenterology and Hepatology, NewYork-Presbyterian Hospital and Weill Cornell Medical Center, New York, New York
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14
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Affiliation(s)
- Shawn L Shah
- Division of Gastroenterology and Hepatology, New York-Presbyterian Hospital and Weill Cornell Medical Center, New York, New York
| | - Sanad Dawod
- Division of Gastroenterology and Hepatology, New York-Presbyterian Hospital and Weill Cornell Medical Center, New York, New York
| | - Qais Dawod
- Division of Gastroenterology and Hepatology, New York-Presbyterian Hospital and Weill Cornell Medical Center, New York, New York
| | - Reem Z Sharaiha
- Division of Gastroenterology and Hepatology, New York-Presbyterian Hospital and Weill Cornell Medical Center, New York, New York
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Affiliation(s)
- Shawn L Shah
- The Center for Advanced Digestive Care, Division of Gastroenterology and Hepatology, New York-Presbyterian Hospital, Weill Cornell Medical College, New York, New York, USA
| | - David Carr-Locke
- The Center for Advanced Digestive Care, Division of Gastroenterology and Hepatology, New York-Presbyterian Hospital, Weill Cornell Medical College, New York, New York, USA
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Parsa N, Nieto JM, Powers P, Mitsuhashi S, Abdelqader A, Hadzinakos G, Anderloni AA, Fugazza A, James TW, Arlt A, Ellrichmann M, Aparicio JR, Trindade AJ, Stevens TK, Chahal P, Shah SL, Messallam AA, Lang G, Fejleh MP, Benias PC, Sejpal DV, Jones J, Mir FF, Aghaie Meybodi M, Ichkhanian Y, Vosoughi K, Novikov AA, Irani SS, Pawa R, Ahmed AM, Sedarat A, Hsueh W, Hampe J, Sharaiha RZ, Berzin TM, Willingham FF, Kushnir VM, Brewer Gutierrez OI, Ngamruengphong S, Huggett MT, Baron TH, Repici A, Adler DG, Nasr JT, Kowalski TE, Kumbhari V, Singh VK, Khashab MA. Endoscopic ultrasound-guided drainage of pancreatic walled-off necrosis using 20-mm versus 15-mm lumen-apposing metal stents: an international, multicenter, case-matched study. Endoscopy 2020; 52:211-219. [PMID: 32000275 DOI: 10.1055/a-1096-3299] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUNDS Endoscopic ultrasound (EUS)-guided placement of lumen-apposing metal stents (LAMSs) has gained popularity for the treatment of pancreatic walled-off necrosis (WON). We compared the 20-mm and 15-mm LAMSs for the treatment of symptomatic WON in terms of clinical success and adverse events. METHODS We conducted a retrospective, case-matched study of 306 adults at 22 tertiary centers from 04/2014 to 10/2018. A total of 102 patients with symptomatic WON who underwent drainage with 20-mm LAMS (cases) and 204 patients who underwent drainage with 15-mm LAMS (controls) were matched by age, sex, and drainage approach. Conditional logistic regression analysis was performed to compare clinical success (resolution of WON on follow-up imaging without reintervention) and adverse events (according to American Society for Gastrointestinal Endoscopy criteria). RESULTS Clinical success was achieved in 92.2 % of patients with 20-mm LAMS and 91.7 % of patients with 15-mm LAMS (odds ratio 0.92; P = 0.91). Patients with 20-mm LAMS underwent fewer direct endoscopic necrosectomy (DEN) sessions (mean 1.3 vs. 2.1; P < 0.001), despite having larger WON collections (transverse axis 118.2 vs. 101.9 mm, P = 0.003; anteroposterior axis 95.9 vs. 80.1 mm, P = 0.01). There was no difference in overall adverse events (21.6 % vs. 15.2 %; P = 0.72) and bleeding events (4.9 % vs. 3.4 %; P = 0.54) between the 20-mm and 15-mm LAMS groups, respectively. CONCLUSIONS The 20-mm LAMS showed comparable clinical success and safety profile to the 15-mm LAMS, with the need for fewer DEN sessions for WON resolution.
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Affiliation(s)
- Nasim Parsa
- University of Missouri Health System, Columbia, Missouri, United States
| | - Jose M Nieto
- Borland Groover Clinic, Jacksonville, Florida, United States
| | - Patrick Powers
- University of Utah School of Medicine, Huntsman Cancer Hospital, Salt Lake City, Utah, United States
| | - Shuji Mitsuhashi
- Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, United States
| | | | | | | | | | - Theodore W James
- University of North Carolina, Chapel Hill, North Carolina, United States
| | | | | | | | - Arvind J Trindade
- Zucker School of Medicine at Hofstra/Northwell, Northwell Health System, New York, New York, United States
| | | | | | - Shawn L Shah
- New York-Presbyterian/Weill Cornell Medical Center, New York, New York, United States
| | - Ahmed A Messallam
- Emory University School of Medicine, Atlanta, Georgia, United States
| | - Gabriel Lang
- Washington University School of Medicine, St Louis, Missouri, United States
| | | | - Petros C Benias
- Zucker School of Medicine at Hofstra/Northwell, Northwell Health System, New York, New York, United States
| | - Divyesh V Sejpal
- Zucker School of Medicine at Hofstra/Northwell, Northwell Health System, New York, New York, United States
| | - Jason Jones
- Wake Forest Baptist Medical Center, Winston Salem, North Carolina, United States
| | - Fahad Faisal Mir
- Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States
| | | | | | - Kia Vosoughi
- Johns Hopkins Hospital, Baltimore, Maryland, United States
| | - Aleksey A Novikov
- Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, United States
| | - Shayan S Irani
- Virginia Mason Medical Center, Seattle, Washington, United States
| | - Rishi Pawa
- Wake Forest Baptist Medical Center, Winston Salem, North Carolina, United States
| | - Ali M Ahmed
- University of Alabama, Birmingham, Alabama, United States
| | | | - William Hsueh
- West Virginia University Hospital, Morgantown, West Virginia, United States
| | - Jochen Hampe
- University Hospital Carl Gustav Carus Dresden, Dresden, Germany
| | - Reem Z Sharaiha
- New York-Presbyterian/Weill Cornell Medical Center, New York, New York, United States
| | - Tyler M Berzin
- Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States
| | | | - Vladimir M Kushnir
- Washington University School of Medicine, St Louis, Missouri, United States
| | | | | | | | - Todd H Baron
- University of North Carolina, Chapel Hill, North Carolina, United States
| | - Alessandro Repici
- Digestive Endoscopy Unit, Humanitas Research Hospital, Rozzano, Italy
| | - Douglas G Adler
- University of Utah School of Medicine, Huntsman Cancer Hospital, Salt Lake City, Utah, United States
| | - John T Nasr
- West Virginia University Hospital, Morgantown, West Virginia, United States
| | - Thomas E Kowalski
- Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, United States
| | - Vivek Kumbhari
- Johns Hopkins Hospital, Baltimore, Maryland, United States
| | - Vikesh K Singh
- Johns Hopkins Hospital, Baltimore, Maryland, United States
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Patel A, Namn Y, Shah SL, Scherl E, Wan DW. Takotsubo cardiomyopathy after an upper and lower endoscopy: a case report and review of the literature. J Med Case Rep 2019; 13:81. [PMID: 30905321 PMCID: PMC6432745 DOI: 10.1186/s13256-019-2014-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2018] [Accepted: 02/12/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Gastrointestinal endoscopies are safe and follow guidelines that emphasize patient care. Although adverse outcomes are rare, high-risk patients may be predisposed to certain events. CASE PRESENTATION We report a unique case of a Caucasian woman with takotsubo cardiomyopathy following an upper and lower endoscopy. CONCLUSIONS Our report suggests the importance of understanding possible endoscopic complications in patients who may experience stress cardiomyopathy.
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Affiliation(s)
- Ashruta Patel
- Philadelphia College of Osteopathic Medicine - Georgia Campus, 625 Peachtree Road NW, Suwanee, GA, 30024, USA. .,Department of Medicine, Division of Gastroenterology and Hepatology, New York-Presbyterian Hospital/Weill Cornell Medicine, 1305 York Avenue, New York, NY, 10022, USA.
| | - Yunseok Namn
- Department of Medicine, Division of Gastroenterology and Hepatology, New York-Presbyterian Hospital/Weill Cornell Medicine, 1305 York Avenue, New York, NY, 10022, USA
| | - Shawn L Shah
- Department of Medicine, Division of Gastroenterology and Hepatology, New York-Presbyterian Hospital/Weill Cornell Medicine, 1305 York Avenue, New York, NY, 10022, USA
| | - Ellen Scherl
- Department of Medicine, Division of Gastroenterology and Hepatology, New York-Presbyterian Hospital/Weill Cornell Medicine, 1305 York Avenue, New York, NY, 10022, USA
| | - David W Wan
- Department of Medicine, Division of Gastroenterology and Hepatology, New York-Presbyterian Hospital/Weill Cornell Medicine, 1305 York Avenue, New York, NY, 10022, USA
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18
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Russo N, Brown RS, Shah SL, Krisko TI, Krumm CS, Nicholls HT, Mousa O, Malhi H, Schwartz RE, Lominadze Z, Rosenblatt R, Fortune BE, Pisa JF, Jesudian AB, Gupta V, Tafesh ZH. Hepatology Highlights. Hepatology 2019; 69:469-472. [PMID: 30695118 DOI: 10.1002/hep.30511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Affiliation(s)
| | - Robert S Brown
- Division of Gastroenterology & Hepatology, Weill Cornell Medical College, New York, NY
| | | | - Tibor I Krisko
- Division of Gastroenterology & Hepatology, Weill Cornell Medical College, New York, NY
| | | | - Hayley T Nicholls
- Division of Gastroenterology & Hepatology, Weill Cornell Medical College, New York, NY
| | | | | | - Robert E Schwartz
- Division of Gastroenterology & Hepatology, Weill Cornell Medical College, New York, NY
| | | | | | - Brett E Fortune
- Division of Gastroenterology & Hepatology, Weill Cornell Medical College, New York, NY
| | | | - Arun B Jesudian
- Division of Gastroenterology & Hepatology, Weill Cornell Medical College, New York, NY
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Shah SL, Aronne LJ, Sharaiha RZ. Setting Up An Endobariatric Weight Loss Program. Am J Gastroenterol 2018; 113:1567-1569. [PMID: 29867177 DOI: 10.1038/s41395-018-0077-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2017] [Accepted: 03/21/2018] [Indexed: 12/11/2022]
Affiliation(s)
- Shawn L Shah
- Division of Gastroenterology and Hepatology, New York-Presbyterian/Weill Cornell Medical Center, New York, NY, USA. Comprehensive Weight Control Center, Division of Endocrinology, Diabetes, and Metabolism, Weill Cornell Medicine, New York, NY, USA
| | - Louis J Aronne
- Division of Gastroenterology and Hepatology, New York-Presbyterian/Weill Cornell Medical Center, New York, NY, USA. Comprehensive Weight Control Center, Division of Endocrinology, Diabetes, and Metabolism, Weill Cornell Medicine, New York, NY, USA
| | - Reem Z Sharaiha
- Division of Gastroenterology and Hepatology, New York-Presbyterian/Weill Cornell Medical Center, New York, NY, USA. Comprehensive Weight Control Center, Division of Endocrinology, Diabetes, and Metabolism, Weill Cornell Medicine, New York, NY, USA
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20
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Shah SL, Karadesh S, Dawod E, Saumoy M, Afaneh C, Sharaiha RZ. Endoscopic ultrasound-guided transrectal pelvic abscess drainage using a lumen-apposing metal stent. Endoscopy 2018; 50:E254-E255. [PMID: 29954006 DOI: 10.1055/a-0624-1609] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Affiliation(s)
- Shawn L Shah
- Division of Gastroenterology and Hepatology, New York-Presbyterian/Weill Cornell Medical Center, New York, New York, USA
| | - Salem Karadesh
- Division of Gastroenterology and Hepatology, New York-Presbyterian/Weill Cornell Medical Center, New York, New York, USA
| | - Enad Dawod
- Division of Gastroenterology and Hepatology, New York-Presbyterian/Weill Cornell Medical Center, New York, New York, USA
| | - Monica Saumoy
- Division of Gastroenterology and Hepatology, New York-Presbyterian/Weill Cornell Medical Center, New York, New York, USA
| | - Cheguevara Afaneh
- Department of Surgery, New York-Presbyterian/Weill Cornell Medical Center, New York, New York, USA
| | - Reem Z Sharaiha
- Division of Gastroenterology and Hepatology, New York-Presbyterian/Weill Cornell Medical Center, New York, New York, USA
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21
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Shah SL, Sharma S, Dawod Q, Hajifathalian K, Saumoy M, Sonoda T, Sharaiha RZ. Double-balloon platform-assisted rectal endoscopic submucosal dissection. Endoscopy 2018; 50:E252-E253. [PMID: 29954007 DOI: 10.1055/a-0606-4862] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Shawn L Shah
- Division of Gastroenterology & Hepatology, New York Presbyterian-Weill Cornell Medical Center, New York, New York, USA
| | - Sam Sharma
- Department of Surgery, New York Presbyterian-Weill Cornell Medical Center, New York, New York, USA
| | - Qais Dawod
- Division of Gastroenterology & Hepatology, New York Presbyterian-Weill Cornell Medical Center, New York, New York, USA
| | - Kaveh Hajifathalian
- Division of Gastroenterology & Hepatology, New York Presbyterian-Weill Cornell Medical Center, New York, New York, USA
| | - Monica Saumoy
- Division of Gastroenterology & Hepatology, New York Presbyterian-Weill Cornell Medical Center, New York, New York, USA
| | - Toyooki Sonoda
- Department of Surgery, New York Presbyterian-Weill Cornell Medical Center, New York, New York, USA
| | - Reem Z Sharaiha
- Division of Gastroenterology & Hepatology, New York Presbyterian-Weill Cornell Medical Center, New York, New York, USA
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Shah SL, Anderson JC, Shatzel JJ, Toor A, Dickson RC. The Epidemiology and Clinical Associations of Portal Vein Thrombosis in Hospitalized Patients With Cirrhosis: A Nationwide Analysis From the National Inpatient Sample. J Hosp Med 2018; 13:324-325. [PMID: 29240852 DOI: 10.12788/jhm.2888] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- Shawn L Shah
- Division of Gastroenterology and Hepatology, NewYork-Presbyterian/Weill Cornell Medical Center, New York, New York, USA
| | - Joseph C Anderson
- White River Junction Veterans Affairs Medical Center, White River Junction, Vermont, USA
- Geisel School of Medicine, Dartmouth-Hitchcock Medical Center, Dartmouth University, Hanover, New Hampshire, USA
| | - Joseph J Shatzel
- Division of Hematology and Medical Oncology, Oregon Health and Science University, Portland, Oregon, USA
| | - Arifa Toor
- Division of Gastroenterology and Hepatology, Mayo Clinic, Phoenix, Arizona, USA
| | - Rolland C Dickson
- Division of Gastroenterology and Hepatology, Mayo Clinic, Phoenix, Arizona, USA.
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Affiliation(s)
- Shawn L Shah
- Division of Gastroenterology and Hepatology, New York-Presbyterian/Weill Cornell Medical Center, New York, New York, United States
| | - Enad Dawod
- Division of Gastroenterology and Hepatology, New York-Presbyterian/Weill Cornell Medical Center, New York, New York, United States
| | - Michel Kahaleh
- Division of Gastroenterology and Hepatology, New York-Presbyterian/Weill Cornell Medical Center, New York, New York, United States
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Affiliation(s)
- Shawn L Shah
- Division of Gastroenterology and Hepatology, New York-Presbyterian/Weill Cornell Medical Center, New York, New York, USA
| | - Ming-Ming Xu
- Division of Gastroenterology and Hepatology, New York-Presbyterian/Weill Cornell Medical Center, New York, New York, USA
| | - Enad Dawod
- Division of Gastroenterology and Hepatology, New York-Presbyterian/Weill Cornell Medical Center, New York, New York, USA
| | - Karim Halazun
- Division of Gastroenterology and Hepatology, New York-Presbyterian/Weill Cornell Medical Center, New York, New York, USA
| | - Reem Z Sharaiha
- Division of Gastroenterology and Hepatology, New York-Presbyterian/Weill Cornell Medical Center, New York, New York, USA
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Arifin BMS, Munaro CJ, Angarita OFB, Cypriano MVG, Shah SL. Actuator stiction compensation via variable amplitude pulses. ISA Trans 2018; 73:239-248. [PMID: 29336789 DOI: 10.1016/j.isatra.2018.01.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/20/2017] [Revised: 12/18/2017] [Accepted: 01/01/2018] [Indexed: 06/07/2023]
Abstract
A novel model free stiction compensation scheme is developed which eliminates the oscillations and also reduces valve movement, allowing good setpoint tracking and disturbance rejection. Pulses with varying amplitude are added to the controller output to overcome stiction and when the error becomes smaller than a specified limit, the compensation ceases and remains in a standby mode. The compensation re-starts as soon as the error exceeds the user specified threshold. The ability to cope with uncertainty in friction is a feature achieved by the use of pulses of varying amplitude. The algorithm has been evaluated via simulation and by application on an industrial DCS system interfaced to a pilot scale process with features identical to those found in industry including a valve positioner.
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Affiliation(s)
- B M S Arifin
- Department of Chemical and Materials Engineering, University of Alberta, Edmonton, T6G 2V4, Canada.
| | - C J Munaro
- Departamento de Engenharia Elétrica, UFES, Av Fernando Ferrari, 514, CEP 29075-910, Vitória, ES, Brazil.
| | - O F B Angarita
- Departamento de Engenharia Elétrica, UFES, Av Fernando Ferrari, 514, CEP 29075-910, Vitória, ES, Brazil
| | - M V G Cypriano
- Departamento de Engenharia Elétrica, UFES, Av Fernando Ferrari, 514, CEP 29075-910, Vitória, ES, Brazil.
| | - S L Shah
- Department of Chemical and Materials Engineering, University of Alberta, Edmonton, T6G 2V4, Canada.
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Shah SL, Lacy BE, DiBaise JK, Vela MF, Crowell MD. The impact of obesity on oesophageal acid exposure time on and off proton pump inhibitor therapy. Aliment Pharmacol Ther 2015; 42:1093-100. [PMID: 26345151 DOI: 10.1111/apt.13394] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2015] [Revised: 06/11/2015] [Accepted: 08/12/2015] [Indexed: 12/21/2022]
Abstract
BACKGROUND Obesity is associated with increased oesophageal acid exposure time (AET) in patients with gastro-oesophageal reflux (GER), and may decrease the effects of proton pump inhibitors (PPIs). AIM To evaluate the effects of increased body mass on the ability of PPI therapy to decrease AET in patients with reflux symptoms. METHODS Acid exposure time profiles collected from adult patients using wireless pH-metry while on or off PPI therapy was retrospectively reviewed. Patients were separated into five body mass index (BMI) categories as defined by the World Health Organization. A multivariable logistic regression evaluated the association between abnormal AET and BMI groups while controlling for age, gender and pH capsule placement methods. RESULTS The study group comprised 968 patients with 336 (34.7%) studied on a PPI and 632 (65.3%) studied off PPI therapy. AET (total greater than 5.3%) was found more frequently in the overweight (67%) and obese classes (74-80%) compared to those who were normal weight (40%) while off acid-suppressing medications (P < 0.001). No significant differences were found between these groups when studied on acid-suppressing medications, and the proportion of patients with abnormal AET across BMI classes was similar regardless of taking a PPI either once or twice daily. CONCLUSIONS This is the largest study to report on the relationship between BMI and oesophageal acid exposure time in patients with GER on and off PPI therapy. We conclude that obesity is related to increased acid exposure time, but with no significant difference in acid exposure time among different weight-based groups when taking a once or twice-daily PPI.
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Affiliation(s)
- S L Shah
- Division of Gastroenterology and Hepatology, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
| | - B E Lacy
- Division of Gastroenterology and Hepatology, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
| | - J K DiBaise
- Division of Gastroenterology and Hepatology, Mayo Clinic, Scottsdale, AZ, USA
| | - M F Vela
- Division of Gastroenterology and Hepatology, Mayo Clinic, Scottsdale, AZ, USA
| | - M D Crowell
- Division of Gastroenterology and Hepatology, Mayo Clinic, Scottsdale, AZ, USA
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Yang F, Shah SL, Xiao D, Chen T. Improved correlation analysis and visualization of industrial alarm data. ISA Trans 2012; 51:499-506. [PMID: 22503464 DOI: 10.1016/j.isatra.2012.03.005] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/13/2011] [Revised: 03/12/2012] [Accepted: 03/23/2012] [Indexed: 05/31/2023]
Abstract
The problem of multivariate alarm analysis and rationalization is complex and important in the area of smart alarm management due to the interrelationships between variables. The technique of capturing and visualizing the correlation information, especially from historical alarm data directly, is beneficial for further analysis. In this paper, the Gaussian kernel method is applied to generate pseudo continuous time series from the original binary alarm data. This can reduce the influence of missed, false, and chattering alarms. By taking into account time lags between alarm variables, a correlation color map of the transformed or pseudo data is used to show clusters of correlated variables with the alarm tags reordered to better group the correlated alarms. Thereafter correlation and redundancy information can be easily found and used to improve the alarm settings; and statistical methods such as singular value decomposition techniques can be applied within each cluster to help design multivariate alarm strategies. Industrial case studies are given to illustrate the practicality and efficacy of the proposed method. This improved method is shown to be better than the alarm similarity color map when applied in the analysis of industrial alarm data.
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Affiliation(s)
- F Yang
- Department of Chemical & Materials Engineering, University of Alberta, Edmonton, AB T6G 2V4, Canada.
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Shah SL, Altindag A. Hematological parameters of tench (Tinca tinca L.) after acute and chronic exposure to lethal and sublethal mercury treatments. Bull Environ Contam Toxicol 2004; 73:911-918. [PMID: 15669737 DOI: 10.1007/s00128-004-0513-y] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Affiliation(s)
- S L Shah
- Pakistan Science Foundation, G-5/2, Islamabad, Pakistan
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Kwok KE, Shah SL, Clanachan AS, Finegan BA. Evaluation of a long-range adaptive predictive controller for computerized drug delivery systems. IEEE Trans Biomed Eng 1995; 42:79-86. [PMID: 7851934 DOI: 10.1109/10.362915] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
A closed-loop adaptive control system, based on the generalized predictive control law with a terminal matching condition, has been developed for computerized drug delivery. The control law is a minimization of the squares of prediction errors over a small future prediction horizon plus weighted square of the prediction error at steady-state. A control-relevant, long-range identification algorithm is used for on-line parameter estimation. Since the control and identification are mutually compatible, the system truly satisfies the approximate dual control criterion. The system has been applied to the control of mean arterial pressure (MAP) by automatic infusion of sodium nitroprusside in the presence of physical and physiological constraints. Experimental evaluation on six mongrel dogs, in an ethics-approved manner, included setpoint tracking and regulation of MAP in the presence of unpredictable disturbances. The system was found to be capable of inducing hypotension in an average of 2.44 +/- 0.31 min (mean +/- standard error of mean) after probing without any overshoots in mean arterial pressure. The nitroprusside infusion was also free of any ringing. When the subjects were not disturbed, 96.2% of mean arterial pressure remained within 5 mm Hg of the target pressure. A series of disturbances introduced in the presence and absence of closed-loop control affirms the robustness and effectiveness of this control system.
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Affiliation(s)
- K E Kwok
- Department of Chemical Engineering, University of British Columbia, Vancouver, Canada
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Abstract
Priapism has been observed during two out of 3,680 filtration leukapheresis procedures in male donors and has been reported during hemodialysis. Both procedures are associated with enhanced granulocyte adhesion and aggregation presumably due to C5a. During both procedures, heparin is administered and this drug has been shown to cause heparin-dependent anti-platelet antibodies. It is suggested that complement mediated venous leukostasis or immune-induced platelet aggregates might impair the normal blood flow from the penis and result in a state of priapism.
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