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Improving sessile serrated adenoma detection rates with high definition colonoscopy:A retrospective study

World Journal of Gastrointestinal Endoscopy 2022年第4期14卷 226-234页

作者： Abhinav Sehgal Soorya Aggarwal rohan mandaliya Thomas Loughney Mark C Mattar Department of Gastroenterology Georgetown University School of MedicineWashingtonDC 20007United States Division of Gastroenterology MedStar Georgetown University HospitalWashingtonDC 20007United States

BACKGROUND Sessile serrated adenomas(SSAs)are important premalignant lesions that are difficult to detect during colonoscopy due to poor definition,concealment by mucous caps,and flat *** definition(HD)colonoscopy may uniquely aid in the detection of these inconspicuous lesions compared to standard definition(SD)*** the absence of existing clinical guidelines to obligate the use of HD colonoscopy for colorectal cancer screening in average-risk patients,demonstrating the benefit of HD colonoscopy on SSA detection rate(SSADR)may help strengthen the evidence to recommend its use in all *** To evaluate the benefit of HD colonoscopy compared to SD colonoscopy on SSADR in average-risk patients undergoing screening *** Data from screening colonoscopies for patients aged 50-76 years two years before and two years after the transition from SD colonoscopy to HD colonoscopy at our large,academic teaching center were *** with symptoms of colorectal disease,positive occult blood test,history of colon polyps,cancer,polyposis syndrome,inflammatory bowel disease or family history of colon cancer or polyps were *** whose endoscopists did not perform colonoscopies both before and after scope definition change were also *** in individual endoscopist SSADR,average SSADR,and overall SSADR with SD colonoscopy vs HD colonoscopy were also evaluated for *** A total of 3657 colonoscopies met eligibility criteria with 2012 colonoscopies from the SD colonoscopy period and 1645 colonoscopies from the HD colonoscopy period from a pool of 11 *** significant improvements of 2.30%in mean SSADR and 2.53%in overall SSADR were noted with HD colonoscopy(P=0.00028 and P=0.00849,respectively).On the individual level,three endoscopists experienced statistically significant benefit with HD colonoscopy(+5.74%,P=0.0056;+4.50%,P=0.0278;+4.84%,P=0.03486).CONCLUSION Our study su

关键词： Colonoscopy High definition Standard definition Sessile serrated adenoma Colorectal cancer screening

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Immune checkpoint inhibitor-induced colitis:A comprehensive review

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World Journal of Clinical Cases 2019年第4期7卷 405-418页

作者： Aniruddh Som rohan mandaliya Dana Alsaadi Maham Farshidpour Aline Charabaty Nidhi Malhotra Mark C Mattar Department of Internal Medicine Medstar Washington Hospital Center Department of Gastroenterology MedStar Georgetown University Hospital Department of Internal Medicine MedStar Georgetown University Hospital Department of Internal Medicine MedStar Union Memorial Hospital and Good Samaritan Hospital Department of Gastroenterology Sibley Memorial Hospital Department of Gastroenterology MedStar Washington Hospital Center

Immune checkpoint inhibitors(ICIs) are monoclonal antibodies that target downregulators of the anti-cancer immune response: Cytotoxic T-lymphocyte antigen-4, programmed cell death protein-1, and its ligand programmed death-ligand *** have revolutionized the treatment of a variety of malignancies. However,many immune-related adverse events have also been described which mainly occurs as the immune system becomes less suppressed, affecting various organs including the gastrointestinal tract and causing diarrhea and colitis. The incidence of immune-mediated colitis(IMC) ranges from 1%-25% depending on the type of ICI and if used in combination. Endoscopically and histologically there is a significant overlap between IMC and inflammatory bowel disease,however more neutrophilic inflammation without chronic inflammation is usually present in IMC. Corticosteroids are recommended for grade 2 or more severe colitis while holding the immunotherapy. About one third to two thirds of patients are steroid refractory and benefit from infliximab. Recently vedolizumab has been found to be efficacious in steroid and infliximab refractory cases. While in grade 4 colitis, the immunotherapy is permanently discontinued, the decision is controversial in grade 3 colitis.

关键词： Immune checkpoint inhibitors Immune-related adverse events Cytotoxic Tlymphocyte-associated antigen 4 Programmed cell death protein 1 Programmed deathligand 1 Immune-mediated colitis

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Monitoring inflammatory bowel disease during pregnancy:Current literature and future challenges

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World Journal of Gastrointestinal Pharmacology and Therapeutics 2018年第1期9卷 1-7页

作者： Tenzin Choden rohan mandaliya Aline Charabaty Mark C Mattar Department of Internal Medicine MedStar Georgetown University HospitalWashingtonDC 20007United States Division of Gastroenterology MedStar Georgetown University HospitalWashingtonDC 20007United States

Inflammatory bowel disease has a high prevalence in women of childbearing age and can have a significant impact on pregnancy, from conceiving to carrying the pregnancy. Active disease during pregnancy is known to have negative effects on pregnancy outcomes; therefore, careful monitoring during this period is an important but challenging aspect of care and is crucial as it affects important management decisions. Recent data seems to suggest that endoscopy is a relatively safe procedure during all trimesters of pregnancy. Serum biomarkers such as C-reactive protein and fecal calprotectin are helpful non-invasive markers, but have shown conflicting results for correlation with disease activity in some initial studies. Further work is necessary to establish standard of care monitoring during pregnancy.

关键词： Inflammatory bowel disease Crohn’s disease Ulcerative colitis Pregnancy Fecal calprotectin

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Role of colonoscopy in diagnosis of capecitabine associated ileitis:Two case reports

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World Journal of Gastrointestinal Endoscopy 2019年第5期11卷 383-388页

作者： Alexander E Dao Angela Hsu Ahmad Nakshabandi rohan mandaliya Sandeep Nadella Anita Sivaraman Mark Mattar Aline Charabaty Department of Gastroenterology Medstar Georgetown University Hospital Department of Gastroenterology Johns Hopkins University at Sibley Memorial Hospital

BACKGROUND Capecitabine is considered a first line agent in adjuvant therapy for breast and colorectal cancer. However,cases of severe diarrhea have been reported with increasing frequency in recent years. When diarrhea is severe and prolonged,capecitabine associated ileitis should be considered as a possible *** SUMMARY Herein,we present two cases of capecitabine ileitis,specifically involving the terminal ileum and ascending colon. We will demonstrate the disease course and treatment modalities applied to alleviate this condition,as well as discuss the merits of using colonoscopy to aid in *** Ultimately our cases demonstrate that symptomatic management with traditional anti-diarrheal medications is largely ineffective. Prompt recognition and discontinuation of capecitabine is an imperative step in proper management of this condition and colonoscopy with biopsy can be helpful when the diagnosis is unclear.

关键词： Capecitabine Xeloda 5-Fluorouracil Ileitis Ileocolitis Colonoscopy Case report

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