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Should gastroenterologists prescribe cannabis? The highs, the lows and the unknowns

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World Journal of Clinical Cases 2023年第18期11卷 4210-4230页

作者： Sonia Samuel Mark Michael micheal tadros Department of Internal Medicine Albany Medical CenterAlbanyNY 12208United States Department of Gastroenterology and Hepatology Albany Medical CenterAlbanyNY 12208United States

Cannabis,commonly known as marijuana,is a drug extracted from the Cannabis plant known for its psychotropic and medicinal *** has been used for healing purposes during ancient times,although its psychoactive components led to its restricted use in ***,cannabis is found to have modulatory effects on the endocannabinoid system exhibiting its medicinal role in the gastrointestinal(GI)*** animal and human studies demonstrate the influential effects of cannabis on a variety of GI diseases including inflammatory bowel disease,motility disorders and GI *** also has a regulatory role in GI symptoms including nausea and vomiting,anorexia,weight gain,abdominal pain,among ***,both its acute and chronic use can lead to undesirable side effects such as dependency and addiction,cognitive impairment and cannabinoid hyperemesis *** will discuss the role of cannabis in the GI system as well as dosing strategies to help guide gastroenterologists to assess its efficacy and provide patient counseling before prescription of medical marijuana.

关键词： Marijuana cannabis Endocannabinoid system Side effects Gastrointestinal disorders

Practical considerations for colorectal cancer screening in older adults

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World Journal of Gastrointestinal Oncology 2022年第6期14卷 1086-1102页

作者： Dana Gornick Anusri Kadakuntla Alexa Trovato Rebecca Stetzer micheal tadros Albany Medical College Albany Medical CollegeAlbanyNY 12208United States Division of Geriatrics Albany Medical CenterAlbanyNY 12208United States Division of Gastroenterology Albany Medical CenterAlbanyNY 12208United States

Recent guidelines recommend that colorectal cancer(CRC)screening after age 75 be considered on an individualized basis,and discourage screening for people over 85 due to competing causes of *** the heterogeneity in the health of older individuals,and lack of data within current guidelines for personalized CRC screening approaches,there remains a need for a clearer framework to inform clinical decision-making.A revision of the current approach to CRC screening in older adults is even more compelling given the improvements in CRC treatment,post-treatment survival,and increasing life expectancy in the *** this review,we aim to examine the personalization of CRC screening cessation based on specific factors influencing life and health expectancy such as comorbidity,frailty,and cognitive *** will also review screening modalities and endoscopic technique for minimizing risk,the risks of screening unique to older adults,and CRC treatment outcomes in older patients,in order to provide important information to aid CRC screening decisions for this age *** review article offers a unique approach to this topic from both the gastroenterologist and geriatrician perspective by reviewing the use of specific clinical assessment tools,and addressing technical aspects of screening colonoscopy and periprocedural management to mitigate screening-related complications.

关键词： Colorectal cancer Colonoscopy Cancer screening Early detection of cancer Aged Elderly

Cautious optimism in anticipation of hepatitis B curative therapies

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World Journal of Virology 2022年第4期11卷 212-215页

作者： Alla Turshudzhyan micheal tadros Department of Medicine University of ConnecticutFarmingtonCT 06030-1235United States Department of Gastroenterology and Hepatology Albany Medical CollegeAlbanyNY 12208United States

Despite relative effectiveness of current hepatitis B therapies,there is still no curative agents *** new emerging approaches hold promise to achieve cure and loss of hepatitis B surface *** or clinical trials investigating new therapies remain small and either focus on patients with low viral load and without hepatotoxic injury or patients with hepatitis D co-infection,which makes it challenging to assess their effectiveness and side effect profile in hepatitis B population.

关键词： Hepatitis B Hepatitis B virus Hepatitis B virus entry inhibitor Bulevirtide Transcription activator-like effector nucleases Zinc-finger nucleases Clustered regularly interspaced short palindromic repeats-associated 9 Nucleocapsid assembly modulators Hepatitis B virus transcription inhibitors Hepatitis B surface antigen release inhibitors

Lessons learned:Preventable misses and near-misses of endoscopic procedures

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World Journal of Gastrointestinal Endoscopy 2022年第5期14卷 302-310页

作者： Alla Turshudzhyan Houman Rezaizadeh micheal tadros Department of Medicine University of ConnecticutFarmingtonCT 06030United States Department of Gastroenterology and Hepatology University of ConnecticutFarmingtonCT 06030United States Department of Gastroenterology and Hepatology Albany Medical CollegeAlbanyNY 12208United States

Endoscopy is a complex procedure that requires advanced training and a highly skilled *** advances in the field of endoscopy have made it an invaluable diagnostic tool,but the procedure remains provider *** quality of endoscopy may vary from provider to provider and,as a result,is not ***,11.3%of upper gastrointestinal neoplasms are missed on the initial upper endoscopy and 2.1%-5.9%of colorectal polyps or cancers are missed on *** is overlooked if endoscopic exam is not done carefully,bypassing proper visualization of the scope’s entry and exit points or,if exam is not taken to completion,not visualizing the most distal bowel *** hope to shed light on this issue,establish areas of weakness,and propose possible solutions and preventative measures.

关键词： High-quality colonoscopy Esophagogastroduodenoscopy EGD Cancer screening endoscopy Missed lesions

Update on Management of Portal Vein Thrombosis and the Role of Novel Anticoagulants

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Journal of Clinical and Translational Hepatology 2019年第2期7卷 154-164页

作者： Matthew Wu Michael Schuster micheal tadros Albany Medical College AlbanyNYUSA Department of Radiology Albany Medical Center HospitalAlbanyNYUSA Department of Gastroenterology Albany Medical Center HospitalAlbanyNYUSA

The clinical management of portal vein thrombosis(PVT)remains ambiguous due to its heterogeneous presentations and its associations with liver disease,malignancy,and hypercoagulable *** natural history and clinical outcome of PVT are highly variable,dependent upon size,extent and degree of the thrombotic occlusion,as well as the physiological impact of patient *** existing clinical guidelines consistently recommend low molecular weight heparin or vitamin K antagonist anticoagulation in cirrhotic patients with symptomatic acute PVT,management of asymptomatic and chronic PVT may need to be determined on a case-by-case basis,factoring in the state of underlying liver *** general,patients with PVT and underlying malignancy should be anticoagulated to alleviate symptoms and prevent recurrences that could disrupt the cancer ***,existing clinical data does not support routine anticoagulation of cirrhotic patients with asymptomatic PVT in the absence of underlying *** low molecular weight heparin and vitamin K antagonist remain the most commonly used agents in PVT,an emerging body of clinical evidence now suggests that direct-acting oral anticoagulants may be used safely and effectively in *** such,direct-acting oral anticoagulants may offer a more convenient anticoagulation alternative for PVT management in future practice.

关键词： Portal vein Thrombosis Liver cirrhosis Neoplasm Anticoagulant

Serrated lesions:A challenging enemy

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World Journal of Gastroenterology 2021年第34期27卷 5625-5629页

作者： Alexa Trovato Alla Turshudzhyan micheal tadros Albany Medical College AlbanyNY 12208United States Department of Medicine University of ConnecticutSchool of MedicineFarmingdaleCT 06032United States Department of Gastroenterology Albany Medical CenterAlbanyNY 12208United States

The serrated pathway accounts for 30%-35%of colorectal cancer(CRC).Unlike hyperplastic polyps,both sessile serrated lesions(SSLs)and traditional serrated adenomas are premalignant lesions,yet SSLs are considered to be the principal serrated precursor of *** lesions represent a challenge in detection,classification,and removal–contributing to post-colonoscopy ***,it is of the utmost importance to characterize these lesions properly to ensure complete removal.A retrospective cohort study developed a diagnostic scoring system for SSLs to facilitate their detection endoscopically and subsequent *** the study,it can be ascertained that both indistinct border and mucus cap are essential in both recognizing and diagnosing serrated *** proximal colon poses technical challenges for some endoscopists,which is why high-quality colonoscopy plays such an important *** indistinct border of some SSLs poses another challenge due to difficult complete ***,it is imperative that gastroenterologists use the key features of mucus cap,indistinct borders,and size of at least five millimeters along with a high-quality colonoscopy and a good bowel preparation to improve the SSL detection rate.

关键词： Sessile serrated lesions Colonoscopy Polyps Colorectal cancer screening Hyperplastic polyps Traditional serrated adenomas

Preoperative physiological esophageal assessment for anti-reflux surgery:A guide for surgeons on high-resolution manometry and pH testing

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World Journal of Gastroenterology 2021年第16期27卷 1751-1769页

作者： Michael Yodice Alexandra Mignucci Virali Shah Christopher Ashley micheal tadros Department of Gastroenterology Albany Medical CollegeAlbanyNY 12208United States Section of Gastroenterology Stratton VA Medical CenterAlbanyNY 12208United States Department of Gastroenterology Albany Medical CenterSchenectadyNY 12309United States

Gastroesophageal reflux disease (GERD) is one of the most commonlyencountered digestive diseases in the world, with the prevalence continuing toincrease. Many patients are successfully treated with lifestyle modifications andproton pump inhibitor therapy, but a subset of patients require more aggressiveintervention for control of their symptoms. Surgical treatment with fundoplicationis a viable option for patients with GERD, as it attempts to improve the integrityof the lower esophageal sphincter (LES). While surgery can be as effective asmedical treatment, it can also be associated with side effects such as dysphagia,bloating, and abdominal pain. Therefore, a thorough pre-operative assessment iscrucial to select appropriate surgical candidates. Newer technologies arebecoming increasingly available to help clinicians identify patients with true LESdysfunction, such as pH-impedance studies and high-resolution manometry(HRM). Pre-operative evaluation should be aimed at confirming the diagnosis ofGERD, ruling out any major motility disorders, and selecting appropriate surgicalcandidates. HRM and pH testing are key tests to consider for patients with GERDlike symptoms, and the addition of provocative measures such as straight legraises and multiple rapid swallows to HRM protocol can assess the presence ofunderlying hiatal hernias and to test a patient’s peristaltic reserve prior tosurgery.

关键词： Gastroesophageal reflux disease Fundoplication High resolution manometry pH-impedance Anti-reflux surgery Pre-operative assessment

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Hepatic Sarcoidosis

Journal of Clinical and Translational Hepatology 2013年第2期1卷 87-93页

作者： micheal tadros Faripour Forouhar George Y.Wu Department of Medicine Division of Gastroenterology-Hepatology University of Connecticut Health Center Farmington CTUSA Department of Anatomic Pathology University of Connecticut Health Center Farmington CT USA

Sarcoidosis is a multisystem disease characterized by the presence of non-caseating granulomas in affected *** involvement is the most common site of disease ***,hepatic involvement is also common in sarcoidosis,occurring in up to 70% of *** patients with liver involvement are ***,the majority of cases are discovered incidentally,frequently by the finding of elevated liver *** in the right upper quadrant of the abdomen,fatigue,pruritus,and jaundice may be associated with liver *** hypertension and cirrhosis are complications linked to long-standing hepatic *** biopsy is usually required to confirm the *** is important to differentiate hepatic sarcoidosis from other autoimmune and granulomatous liver *** all cases of hepatic sarcoidosis require *** symptomatic patients,the first line treatment includes corticosteroids or ursodeoxycholic *** immunosuppressant agents can be used as second line ***,severe cases require liver transplantation.

关键词： Sarcoid Granuloma Epitheloid

Colorectal cancer screening in the COVID-19 era

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World Journal of Gastrointestinal Oncology 2021年第4期13卷 238-251页

作者： Anusri Kadakuntla Tiffany Wang Karen Medgyesy Enxhi Rrapi James Litynski Gillian Adynski micheal tadros Albany Medical College Albany Medical CollegeAlbanyNY 12208United States Division of Gastroenterology Albany Medical CenterAlbanyNY 12208United States National Clinician Scholars Program Duke University School of NursingDurhamNC 27710United States

Colorectal cancer(CRC)is the third most diagnosed form of cancer and second most deadly cancer *** of better screening has improved both incidence and ***,as the coronavirus disease 2019(COVID-19)pandemic began,healthcare resources were shunted away from cancer screening services resulting in a sharp decrease in CRC screening and a backlog of patients awaiting screening *** may have significant effects on CRC cancer mortality,as delayed screening may lead to advanced cancer at *** to overcome COVID-19 related disruption include utilizing stool-based cancer tests,developing screening protocols based on individual risk factors,expanding telehealth,and increasing open access *** this review,we will summarize the effects of COVID-19 on CRC screening,the potential longoutcomes,and ways to adapt CRC screening during this global pandemic.

关键词： Colorectal cancer COVID-19 Colonoscopy Early detection of cancer Diagnostic screening programs Mass screening