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Article ; Online: Risk of Metachronous Neoplasia with High-Risk Adenoma and Synchronous Sessile Serrated Adenoma

Umesha Boregowda / Chandraprakash Umapathy / Juan Echavarria / Shreyas Saligram

Diagnostics, Vol 13, Iss 1569, p

A Systematic Review and Meta-Analysis

2023 Volume 1569

Abstract: Background: Sessile serrated adenomas are important precursors to colorectal cancers and account for 30% of colorectal cancers. The United States Multi-Society Task Force recommends that patients with sessile serrated adenomas undergo surveillance ... ...

Abstract	Background: Sessile serrated adenomas are important precursors to colorectal cancers and account for 30% of colorectal cancers. The United States Multi-Society Task Force recommends that patients with sessile serrated adenomas undergo surveillance similar to tubular adenomas. However, the risk of metachronous neoplasia when the high-risk adenoma co-exists with sessile serrated adenomas is poorly defined. Objective: To examine the risk of metachronous neoplasia in the presence of high-risk adenoma and synchronous sessile serrated adenomas compared with isolated high-risk adenoma. Data sources: PubMed, Embase, Scopus, Cochrane Library. Study selection: A literature search for studies evaluating the risk of metachronous neoplasia in patients with high-risk adenoma alone and those with synchronous high-risk adenoma and sessile serrated adenomas during surveillance colonoscopy was conducted on online databases. Main outcome measures: The primary outcome of interest was the presence of metachronous neoplasia. Results: Of the 1164 records reviewed, six (four retrospective and two prospective) studies met inclusion criteria with 2490 patients (1607 males, mean age 59.98 ± 3.23 years). Average follow-up was 47.5 ± 12.5 months. There were 2068 patients with high-risk adenoma on index colonoscopy and 422 patients with high-risk adenoma and synchronous sessile serrated adenomas. Pooled estimates showed a significantly elevated risk for metachronous neoplasia in patients with high-risk adenoma and synchronous sessile serrated adenomas (pooled odds ratio 2.21; 95% confidence intervals 1.65–2.96; p < 0.01). There was low heterogeneity (I 2 = 11%) among the studies. Sensitivity analysis of the prospective studies alone also showed elevated risk of metachronous neoplasm (pooled odds ratio 2.56; 95%, confidence intervals 1.05–6.23; p = 0.04). Limitations: Inclusion of a small number of retrospective studies. Conclusions: The presence of high-risk adenomas and synchronous sessile serrated adenomas is associated with an ...
Keywords	colorectal cancer ; serrated polyps ; high-risk adenoma ; metachronous neoplasm ; high-grade dysplasia ; surveillance colonoscopy ; Medicine (General) ; R5-920
Subject code	610 ; 332
Language	English
Publishing date	2023-04-01T00:00:00Z
Publisher	MDPI AG
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Endoscopic Management of Complex Colorectal Polyps

Rupinder Mann / Mahesh Gajendran / Chandraprakash Umapathy / Abhilash Perisetti / Hemant Goyal / Shreyas Saligram / Juan Echavarria

Frontiers in Medicine, Vol

Current Insights and Future Trends

2022 Volume 8

Abstract: Most colorectal cancers arise from adenomatous polyps and sessile serrated lesions. Screening colonoscopy and therapeutic polypectomy can potentially reduce colorectal cancer burden by early detection and removal of these polyps, thus decreasing ... ...

Abstract	Most colorectal cancers arise from adenomatous polyps and sessile serrated lesions. Screening colonoscopy and therapeutic polypectomy can potentially reduce colorectal cancer burden by early detection and removal of these polyps, thus decreasing colorectal cancer incidence and mortality. Most endoscopists are skilled in detecting and removing the vast majority of polyps endoscopically during a routine colonoscopy. Polyps can be considered “complex” based on size, location, morphology, underlying scar tissue, which are not amenable to removal by conventional endoscopic polypectomy techniques. They are technically more challenging to resect and carry an increased risk of complications. Most of these polyps were used to be managed by surgical intervention in the past. Rapid advancement in endoscopic resection techniques has led to a decreasing role of surgery in managing these complex polyps. These endoscopic resection techniques do require an expert in the field and advanced equipment to perform the procedure. In this review, we discuss various advanced endoscopic techniques for the management of complex polyps.
Keywords	colorectal polyp ; colorectal cancer ; endoscopic mucosal resection ; endoscopic submucosal dissection ; colonoscopy ; Medicine (General) ; R5-920
Subject code	571
Language	English
Publishing date	2022-01-01T00:00:00Z
Publisher	Frontiers Media S.A.
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Advanced Endoscopic Imaging and Interventions in GERD

Rupinder Mann / Mahesh Gajendran / Abhilash Perisetti / Hemant Goyal / Shreyas Saligram / Chandraprakash Umapathy

Frontiers in Medicine, Vol

An Update and Future Directions

2021 Volume 8

Abstract: Gastroesophageal reflux disease (GERD) is one of the most common gastrointestinal diseases encountered in primary care and gastroenterology clinics. Most cases of GERD can be diagnosed based on clinical presentation and risk factors; however, some ... ...

Abstract	Gastroesophageal reflux disease (GERD) is one of the most common gastrointestinal diseases encountered in primary care and gastroenterology clinics. Most cases of GERD can be diagnosed based on clinical presentation and risk factors; however, some patients present with atypical symptoms, which can make diagnosis difficult. An esophagogastroduodenoscopy can be used to assist in diagnosis of GERD, though only half of these patients have visible endoscopic findings on standard white light endoscopy. This led to the development of new advanced endoscopic techniques that enhanced the diagnosis of GERD and related complications like squamous cell dysplasia, Barrett's esophagus, and early esophageal adenocarcinoma. This is conducted by improved detection of subtle irregularities in the mucosa and vascular structures through optical biopsies in real-time. Management of GERD includes lifestyle modifications, pharmacological therapy, endoscopic and surgical intervention. Minimally invasive endoscopic intervention can be an option in selected patients with small hiatal hernia and without complications of GERD. These endoscopic interventions include endoscopic fundoplication, endoscopic mucosal resection techniques, ablative techniques, creating mechanical barriers, and suturing and stapling devices. As these new advanced endoscopic techniques are emerging, data surrounding the indications, advantages and disadvantages of these techniques need a thorough understanding.
Keywords	gastroesophageal reflux disease (GERD) ; endoscopic reflux therapy ; narrow band imaging (NBI) ; endoscopy ; Barrett's esophagus (BE) ; Medicine (General) ; R5-920
Subject code	610
Language	English
Publishing date	2021-11-01T00:00:00Z
Publisher	Frontiers Media S.A.
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: The two sides of opioids in cyclical vomiting syndrome

Shreyas Saligram / Klaus Bielefeldt

North American Journal of Medical Sciences, Vol 6, Iss 3, Pp 114-

2014 Volume 118

Abstract: Background: Cyclical vomiting syndrome is increasingly recognized in adults, with recent reports suggesting ′coalescing attacks′ in one third of the patients. We hypothesized that the common need for opioid treatment may contribute to coalescing attacks ... ...

Abstract	Background: Cyclical vomiting syndrome is increasingly recognized in adults, with recent reports suggesting ′coalescing attacks′ in one third of the patients. We hypothesized that the common need for opioid treatment may contribute to coalescing attacks through development of opioid dependence and withdrawal, triggering cyclical vomiting syndrome. Aim: This study was to review iatrogenic opioid dependence as the potential cause for triggering cyclical vomiting syndrome. Materials and Methods: A retrospective review was performed to identify patients treated for cyclical vomiting syndrome by a single physician between Jan and December of 2010. Demographic data, clinical presentation, treatment, cumulative opioid prescription during hospitalizations and emergency room visits and days of inpatient stay were abstracted from the chart. Results: Forty-one patients (mean age 37.5.6 ± 2.6 years; 66% female) were seen within this timeframe. In eleven patients (27%) with ongoing opioid use, the initial cyclical illness had progressed and eventually coalesced. A cohort of 23 patients was followed for at least 6 months (12.3 ± 1.7 months). The best single predictor of repeat hospitalizations was the cumulative opioid dosage. Conclusion: Continued use of opioid therapy is a poor prognostic marker of cyclical vomiting syndrome and may contribute to disease coalescence, with dependence and withdrawal triggering recurrent episodes.
Keywords	Cyclical vomiting syndrome ; Coalescing attacks ; Opioids ; Medicine ; R ; Medicine (General) ; R5-920
Subject code	610
Publishing date	2014-01-01T00:00:00Z
Publisher	North American Journal of Medical Sciences
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Goblet cell carcinoid of the appendix – diagnostic challenges and treatment updates

Gregory Gilmore / Kristin Jensen / Shreyas Saligram / Thomas P. Sachdev / Subramanyeswara R. Arekapudi

Journal of Medical Case Reports, Vol 12, Iss 1, Pp 1-

a case report and review of the literature

2018 Volume 7

Abstract: Abstract Background Goblet cell carcinoid is a rare but distinct entity of appendiceal tumors which is a hybrid or mixed tumor consisting of both epithelial (glandular) and neuroendocrine elements containing goblet cells. This entity is important to ... ...

Abstract	Abstract Background Goblet cell carcinoid is a rare but distinct entity of appendiceal tumors which is a hybrid or mixed tumor consisting of both epithelial (glandular) and neuroendocrine elements containing goblet cells. This entity is important to recognize and appropriately grade as it tends to be more aggressive than typical carcinoid tumors, often presenting with metastatic disease. As a result, the 5-year overall survival is 14–22% in stage III–IV disease. GCC therefore warrants more aggressive surgical and medical (chemotherapy) interventions than typical carcinoid tumors. Through this case report we give a brief update on GCC pathological features, staging, surgical management, and review the literature as a guide to indications for chemotherapy and choice of agents. Case presentation We present the case of a 77-year-old Caucasian man with a history of stage I adenocarcinoma of transverse colon status post transverse colectomy who was incidentally found on surveillance colonoscopy to have an abnormal appendiceal orifice lesion. A biopsy revealed an appendiceal goblet cell carcinoid and he underwent a right hemicolectomy which revealed a pathologic stage III GCC for which he received eight cycles of adjuvant chemotherapy with capecitabine. Conclusions It is essential that patients who have tumors > 2 cm, are pT3 or pT4, have higher grade histology with signet ring (Tang grade B or grade C), locally advanced, or with positive surgical margins on appendectomy undergo a right hemicolectomy. Although there is no category 1 evidence, consensus recommendations are that patients with stage II (particularly Tang B and C) and stage III GCC be offered adjuvant chemotherapy with a regimen based on 5-fluorouracil, as these patients are known to have high rates of relapse.
Keywords	Goblet cell carcinoid ; Appendix ; Chemotherapy ; Medicine ; R
Subject code	610
Language	English
Publishing date	2018-09-01T00:00:00Z
Publisher	BMC
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Raised liver enzymes in newly diagnosed Type 2 diabetes are associated with weight and lipids, but not glycaemic control

Shreyas Saligram / Elizabeth J Williams / Michael G Masding

Indian Journal of Endocrinology and Metabolism, Vol 16, Iss 6, Pp 1012-

2012 Volume 1014

Abstract: Introduction: Non-alcoholic fatty liver disease (NAFLD) is associated with Type 2 diabetes (T2DM) and the metabolic syndrome, and can progress to chronic liver disease. We examined the incidence of elevated (>35 iu/l) alanine transaminase (ALT), as a ... ...

Abstract	Introduction: Non-alcoholic fatty liver disease (NAFLD) is associated with Type 2 diabetes (T2DM) and the metabolic syndrome, and can progress to chronic liver disease. We examined the incidence of elevated (>35 iu/l) alanine transaminase (ALT), as a surrogate marker for NAFLD, in patients with newly diagnosed T2DM. Materials and Methods: Retrospective analysis of ALT with metabolic parameters, in 606 consecutive patients presenting to district wide education sessions for newly diagnosed T2DM. Results: ALT was elevated in 155 patients (25.6% (95% CI 22.1, 29.2)), who tended to be older (mean difference 7.3 years (5.2, 9.5), P < 0.001), heavier (body mass index (BMI) mean difference 2.0 kg/m 2 ( 1.0, 3.0), P < 0.001), and more likely to be male (M:F raised ALT 104:51, normal ALT 219:232, P < 0.001), with higher triglycerides (median difference 0.2 mmol/l, P = 0.001) and lower HDL cholesterol (mean difference 0.09 mmol/l (0.02, 0.15), P = 0.001). There were no statistically significant differences in HBA1C or total cholesterol. Conclusions: In a well-defined population of newly diagnosed people with T2DM, there is a high incidence of abnormal ALT levels, which is associated with features of the metabolic syndrome (obesity and lipid abnormalities), but not glycemic control.
Keywords	Alanine transaminase; non-alcoholic fatty liver disease; Type 2 diabetes ; Diseases of the endocrine glands. Clinical endocrinology ; RC648-665 ; Specialties of internal medicine ; RC581-951 ; Internal medicine ; RC31-1245 ; Medicine ; R
Subject code	610
Language	English
Publishing date	2012-01-01T00:00:00Z
Publisher	Endocrine Society of India
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Scope of Artificial Intelligence in Screening and Diagnosis of Colorectal Cancer

Hemant Goyal / Rupinder Mann / Zainab Gandhi / Abhilash Perisetti / Aman Ali / Khizar Aman Ali / Neil Sharma / Shreyas Saligram / Benjamin Tharian / Sumant Inamdar

Journal of Clinical Medicine, Vol 9, Iss 3313, p

2020 Volume 3313

Abstract: Globally, colorectal cancer is the third most diagnosed malignancy. It causes significant mortality and morbidity, which can be reduced by early diagnosis with an effective screening test. Integrating artificial intelligence (AI) and computer-aided ... ...

Abstract	Globally, colorectal cancer is the third most diagnosed malignancy. It causes significant mortality and morbidity, which can be reduced by early diagnosis with an effective screening test. Integrating artificial intelligence (AI) and computer-aided detection (CAD) with screening methods has shown promising colorectal cancer screening results. AI could provide a “second look” for endoscopists to decrease the rate of missed polyps during a colonoscopy. It can also improve detection and characterization of polyps by integration with colonoscopy and various advanced endoscopic modalities such as magnifying narrow-band imaging, endocytoscopy, confocal endomicroscopy, laser-induced fluorescence spectroscopy, and magnifying chromoendoscopy. This descriptive review discusses various AI and CAD applications in colorectal cancer screening, polyp detection, and characterization.
Keywords	artificial intelligence ; colorectal cancer ; colon cancer ; polyp ; screening ; colonoscopy ; Medicine ; R
Subject code	610
Language	English
Publishing date	2020-10-01T00:00:00Z
Publisher	MDPI AG
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Aortic stenosis

Sangeetha Nathaniel / Shreyas Saligram / Antony Leslie Innasimuthu

World Journal of Cardiology, Vol 2, Iss 6, Pp 135-

An update

2010 Volume 139

Abstract: Aortic stenosis (AS) is the most common valvular heart disease in the world. It is a disease of the elderly and as our population is getting older in both the developed and the developing world, there has been an increase in the prevalence of AS. It is ... ...

Abstract	Aortic stenosis (AS) is the most common valvular heart disease in the world. It is a disease of the elderly and as our population is getting older in both the developed and the developing world, there has been an increase in the prevalence of AS. It is impacting the mortality and morbidity of our elderly population. It is also causing a huge burden on the healthcare system. There has been tremendous progress in our understanding of AS in recent years. Lately, studies have shown that AS is not just a disease of the aortic valve but it affects the entire systemic vasculature. There are studies looking at more sophisticated measures of disease severity that might better predict the optimal timing of valve replacement. The improvement in our understanding in etiology and pathophysiology of the disease process has led to a number of trials with possible treatment options for AS. In this review, we talk about our understanding of the disease and latest developments in disease assessment and management. We look forward to a time when there will be medical treatment for AS.
Keywords	Aortic stenosis ; Valvular heart disease ; Diagnosis of aortic stenosis ; Medical management of aortic stenosis ; Diseases of the circulatory (Cardiovascular) system ; RC666-701 ; Specialties of internal medicine ; RC581-951 ; Internal medicine ; RC31-1245 ; Medicine ; R ; DOAJ:Cardiovascular ; DOAJ:Medicine (General) ; DOAJ:Health Sciences
Subject code	610
Language	English
Publishing date	2010-06-01T00:00:00Z
Publisher	Baishideng Publishing
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Endoscopic ultrasound-guided fine-needle aspiration of pancreatic lesions

Bhairvi S Jani / Fadi Rzouq / Shreyas Saligram / Diego Lim / Amit Rastogi / John Bonino / Mojtaba Olyaee

North American Journal of Medical Sciences, Vol 8, Iss 1, Pp 1-

A systematic review of technical and procedural variables

2016 Volume 11

Abstract: Endoscopic ultrasound (EUS)-guided tissue acquisition has emerged over the last decade as an invaluable diagnostic tool in approaching the different pancreatic lesions. Given the safety and minimal invasiveness of this approach combined with the high ... ...

Abstract	Endoscopic ultrasound (EUS)-guided tissue acquisition has emerged over the last decade as an invaluable diagnostic tool in approaching the different pancreatic lesions. Given the safety and minimal invasiveness of this approach combined with the high diagnostic yield, it became the standard of care when dealing with different pancreatic pathologies. However, some variables regarding this procedure remain not fully understood. These can influence the diagnostic yield of the procedure and include the presence of the on-site cytopathologist, the type and size of the needle used as well as obtaining aspiration versus core biopsy, the number of passes and the sampling technique, and the role of suction and stylet use among others. We performed a comprehensive literature search using PubMed, Google Scholar, and Embase for studies that assessed these variables. Eligible studies were analyzed using several parameters such as technique and procedure, with the aim of reviewing results from an evidence-based standpoint.
Keywords	Cytopathology ; endoscopic ultrasound (EUS) ; fine-needle aspiration (FNA) ; fine-needle biopsy (FNB) ; pancreatic lesions ; Medicine ; R ; Medicine (General) ; R5-920
Subject code	500
Publishing date	2016-01-01T00:00:00Z
Publisher	North American Journal of Medical Sciences
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Accuracy of endoscopic ultrasound-guided fine needle aspiration in diagnosing solid pseudopapillary tumor

Shreyas Saligram / Fang Fan / Melissa Oropeza-Vail / Parviz Gholami / Mojtaba Olyaee

North American Journal of Medical Sciences, Vol 5, Iss 12, Pp 716-

2013 Volume 720

Abstract: Background: Solid pseudopapillary tumors are rare pancreatic tumors. Accurate preoperative diagnosis helps in planning of the surgery. Aim: This study was to evaluate accuracy of endoscopic ultrasound-guided fine needle aspiration and ... ...

Abstract	Background: Solid pseudopapillary tumors are rare pancreatic tumors. Accurate preoperative diagnosis helps in planning of the surgery. Aim: This study was to evaluate accuracy of endoscopic ultrasound-guided fine needle aspiration and immunohistochemistry in diagnosing solid pseudopapillary tumors. Materials and Methods: A retrospective review was performed by reviewing medical records to identify patients treated for solid pseudopapillary tumors over a 5-year period. Patients who were noted to have pancreatic lesions by computer tomography abdomen underwent endoscopic ultrasound. Fine needle aspiration was obtained from each of these lesions and subjected to immunohistochemistry. Results: Five patients were identified. Endoscopic ultrasound was able to identify the pancreatic lesions in all five patients noted in computer tomography abdomen. Solid pseudopapillary tumors were diagnosed by immunohistochemistry. All five patients underwent surgery and the resected lesions confirmed solid pseudopapillary tumors in 80% patients. Conclusion: Endoscopic ultrasound-guided fine needle aspiration has a higher degree of accuracy in diagnosing solid pseudopapillary tumors.
Keywords	Endoscopic ultrasound ; fine needle aspiration ; immunohistochemistry ; solid pseudopapillary tumor ; Medicine ; R ; Medicine (General) ; R5-920
Publishing date	2013-01-01T00:00:00Z
Publisher	North American Journal of Medical Sciences
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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