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Management of the Ileal Pouch-Anal Anastomosis in the Elderly
Levine, Irving; Chang, Shannon
ISI:000426695600004
ISSN: 0277-4208
CID: 5524122
Interactions Between Inflammatory Bowel Disease Drugs and Chemotherapy
Leung, Galen; Papademetriou, Marianna; Chang, Shannon; Arena, Francis; Katz, Seymour
OPINION STATEMENT: As new and effective novel therapies in inflammatory bowel disease (IBD) become available, patients are living longer with advancing age and are at increased risk for malignancy. The management of IBD and malignancy involves multiple combinations of chemotherapy agents and IBD drugs, with the potential for interactions between these therapies. Interactions may either potentiate the effectiveness of drug class or exacerbate their common side effects. In this review article, we present a guide on studied interactions between IBD therapies and chemotherapy agents, specifically those of colorectal cancer, breast cancer, non-Hodgkin's lymphoma, and melanoma. The pharmacology and pharmocokinetics of each IBD drug will be discussed. Then, the IBD drug and chemotherapy interactions are summarized in table format. This guide will provide a quick reference to guide clinicians with this challenging management of two disease processes.
PMID: 27709332
ISSN: 1092-8472
CID: 2274212
When Life Throws You a Scurveball [Meeting Abstract]
Mitchell, Oscar; Chang, Shannon
ISI:000395764603505
ISSN: 1572-0241
CID: 2492692
Worsening Hepatic Function in Paroxysmal Nocturnal Hemoglobinuria (PNH) Leading to Hemolysis, Gallstones, and Progressive Hepatic Fibrosis [Meeting Abstract]
Mone, Anjali; Chang, Shannon; Poppers, David
ISI:000395764603112
ISSN: 1572-0241
CID: 2492632
Cyclosporine Rescue in Vedolizumab Patients with Steroid-Refractory Severe Ulcerative Colitis: A Case Series [Meeting Abstract]
Pineles, David; Chang, Shannon; Hudesman, David
ISI:000395764603058
ISSN: 1572-0241
CID: 2492612
Making the Cut: An Isolated Filiform Polyp
Chang, Shannon; Pochapin, Mark; Khan, Abraham
PMID: 26829027
ISSN: 1542-7714
CID: 2243592
The Effect of Colonoscopy Reimbursement Reductions on Gastroenterologist Practice Behavior
McNeill, Matthew B; Chang, Shannon; Sahebjam, Farhad; Goodman, Adam J; Gross, Seth A; Sigal, Samuel H
GOAL: The purpose of this study was to assess the effect of decreased colonoscopy reimbursement on gastroenterologist practice behavior, including time to retirement and procedure volume. BACKGROUND: In 2015, the Centers for Medicare and Medicaid Services proposed reductions in colonoscopy reimbursements. With new initiatives for increased colorectal cancer screening, it is crucial to understand how reimbursement changes could affect these efforts. STUDY: Randomly selected respondents from the American College of Gastroenterology membership database were surveyed on incremental changes in practice behavior if colonoscopy reimbursement were to decrease by 10, 20, 30, or 40 %. Data were analyzed using both Pearson's Chi-square and analysis of variance. RESULTS: Two thousand and nine gastroenterologists received the survey with a 16.3 % response rate. Procedure volume significantly decreased with degree of reimbursement reductions (p < 0.001). With a 10 % decrease, 72 % of respondents reported no change in the number of colonoscopies performed. With a 20 % decrease, 39 % would decrease their procedure volume, while 21 % of respondents would increase their procedure volume. With a 30 and 40 % decrease, procedure volume decreased by 48 and 50 %, respectively. In terms of retirement, current plans predict a cumulative retirement rate of 29.4 % at 10 years. More than 42 % of respondents plan to retire after 2030. In the 2014-2023 retirement subgroup (N = 74 responses), there was a significant hastening of retirement year at 20 % (p = 0.016), 30 % (p < 0.001), and 40 % (p < 0.001) reimbursement reductions as compared to baseline responses. CONCLUSION: Decreasing colonoscopy reimbursements may have a significant effect on the effective gastroenterology work force.
PMID: 26781428
ISSN: 1573-2568
CID: 1922072
Disease monitoring in inflammatory bowel disease
Chang, Shannon; Malter, Lisa; Hudesman, David
The optimal method for monitoring quiescent disease in patients with Crohn's disease (CD) and ulcerative colitis is yet to be determined. Endoscopic evaluation with ileocolonoscopy is the gold standard but is invasive, costly, and time-consuming. There are many commercially available biomarkers that may be used in clinical practice to evaluate disease status in patients with inflammatory bowel disease (IBD), but the most widely adopted biomarkers are C-reactive protein (CRP) and fecal calprotectin (FC). This review summarizes the evidence for utilizing CRP and FC for monitoring IBD during clinical remission and after surgical resection. Endoscopic correlation with CRP and FC is evaluated in each disease state. Advantages and drawbacks of each biomarker are discussed with special consideration of isolated ileal CD. Fecal immunochemical testing, traditionally used for colorectal cancer screening, is mentioned as a potential new alternative assay in the evaluation of IBD. Based on a mixture of information gleaned from biomarkers, clinical status, and endoscopic evaluation, the best treatment decisions can be made for the patient with IBD.
PMCID:4616202
PMID: 26523100
ISSN: 2219-2840
CID: 1873112
In vivo classification of colorectal neoplasia using high-resolution microendoscopy: Improvement with experience
Parikh, Neil D; Perl, Daniel; Lee, Michelle H; Chang, Shannon S; Polydorides, Alexandros D; Moshier, Erin; Godbold, James; Zhou, Elinor; Mitcham, Josephine; Richards-Kortum, Rebecca; Anandasabapathy, Sharmila
BACKGROUND AND AIMS: High-resolution microendoscopy (HRME) is a novel, low-cost "optical biopsy" technology that allows for subcellular imaging. The study aim was to evaluate the learning curve of HRME for the differentiation of neoplastic from non-neoplastic colorectal polyps. METHODS: In a prospective cohort fashion, a total of 162 polyps from 97 patients at a single tertiary care center were imaged by HRME and classified in real time as neoplastic (adenomatous, cancer) or non-neoplastic (normal, hyperplastic, inflammatory). Histopathology was the gold standard for comparison. Diagnostic accuracy was examined at three intervals over time throughout the study; the initial interval included the first 40 polyps, the middle interval included the next 40 polyps examined, and the final interval included the last 82 polyps examined. RESULTS: Sensitivity increased significantly from the initial interval (50%) to the middle interval (94%, P = 0.02) and the last interval (97%, P = 0.01). Similarly, specificity was 69% for the initial interval but increased to 92% (P = 0.07) in the middle interval and 96% (P = 0.02) in the last interval. Overall accuracy was 63% for the initial interval and then improved to 93% (P = 0.003) in the middle interval and 96% (P = 0.0007) in the last interval. CONCLUSIONS: In conclusion, this in vivo study demonstrates that an endoscopist without prior colon HRME experience can achieve greater than 90% accuracy for identifying neoplastic colorectal polyps after 40 polyps imaged. HRME is a promising modality to complement white light endoscopy in differentiating neoplastic from non-neoplastic colorectal polyps.
PMCID:4504008
PMID: 25753782
ISSN: 1440-1746
CID: 1640092
Characteristics of Gastrointestinal Bleeding After Placement of Continuous-Flow Left Ventricular Assist Device: A Case Series
Marsano, Joseph; Desai, Jay; Chang, Shannon; Chau, Michelle; Pochapin, Mark; Gurvits, Grigoriy E
BACKGROUND: Medical management of patients with continuous-flow left ventricular assist devices (LVADs) remains challenging for the gastroenterologist given their high risk of gastrointestinal bleeding (GIB) and need for continuous anticoagulation. AIMS: Our aim was to better characterize LVAD patients who presented with a GIB at our facility and delineate the prevalence, presentation, time to diagnosis, management, and therapeutic endoscopic interventions, including small bowel tools that may offer additional benefit. METHODS: We retrospectively reviewed adult patients (>18 years) who underwent LVAD implantation at our tertiary care facility between October 2011 and October 2013. Electronic medical records were reviewed for presenting symptoms, average days to initial and repeat GIB, hospital course, and techniques that led to diagnosis and hemostasis. RESULTS: Eighteen patients underwent LVAD implantation, of which 61 % presented with a GIB for a total of 20 presentations (1.8 per patient). Mean time to initial GIB was 154 days. Patients required an average of 1.8 endoscopic procedures per admission. Esophagogastroduodenoscopy (EGD) and push enteroscopy (PE) were more likely to lead to a diagnosis, and EGD was the most commonly used diagnostic tool at initial presentation. Sixty percent of patients who initially received EGD presented with a recurrent GIB and required PE, which was diagnostic and therapeutic for small bowel angiodysplasias in 80 % of cases. CONCLUSION: We found a higher GIB rate compared with prior studies. Bleeding events were associated with multiple procedures and interventions. We recommend an algorithmic approach to LVAD patients who bleed. Our experience suggests that PE is warranted at initial presentation in order to achieve hemostasis, prevent recurrent GIB, and decrease subsequent readmission rates.
PMID: 25616611
ISSN: 0163-2116
CID: 1447322