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Biomedical subjects

Nicholas J Shaheen

Publications and source records attributed to Nicholas J Shaheen.

45 records · Page 3Linked to original sources
PubMed2002

Chemoprevention of gastrointestinal malignancies with nonsteroidal antiinflammatory drugs.

In multiple studies, the chronic use of nonsteroidal antiinflammatory drugs (NSAIDs) has been associated with a decreased incidence of several types of gastrointestinal (GI) neoplasia. This effect may be mediated by one of several intracellular mechanisms, some of which involve the inhibition of the cyclooxygenase-2 (COX-2) isoenzyme. In multiple studies of colorectal carcinoma, chronic NSAID use has shown a protective effect, with the majority of studies demonstrating a 30-70% risk reduction associated with NSAID use. The effect of NSAIDs on other types of GI neoplasia is less clear, but evidence suggests that chronic NSAID use may diminish the risk of esophageal and gastric carcinomas. Data assessing the effects of NSAIDs on the incidence of pancreatic and hepatic malignancies currently are too sparse and inconsistent to draw any conclusions. The newer COX-2 specific agents may provide a less GI-toxic alternative to nonselective NSAIDs as chemoprotective agents.

Animals↗
PubMed2002

Upper endoscopy as a screening and surveillance tool in esophageal adenocarcinoma: a review of the evidence.

Esophageal adenocarcinoma is a rare cancer that is increasing rapidly in incidence. Because gastroesophageal reflux disease (GERD) is a risk factor for the development of this cancer, endoscopic screening of individuals with GERD symptoms and endoscopic surveillance of those who are found to have Barrett's esophagus (BE), the presumed precursor to adenocarcinoma, have been proposed. Although no direct data support endoscopic screening or surveillance, several lines of indirect evidence are available. We apply a set of criteria for the evaluation of screening programs to endoscopic screening of subjects with reflux and endoscopic surveillance of subjects with BE. A critical examination of the data supporting these practices shows that considerable gaps exist in our knowledge regarding endoscopy as a screening test in GERD, making us unable to support this practice based on current evidence. Although no controlled trials exist to substantiate the effectiveness of surveillance programs for subjects with BE, some stronger indirect evidence does support this practice. However, further studies are necessary to substantiate the effectiveness and cost-effectiveness of endoscopic surveillance in BE. Based on the currently available data, consideration should be given to expanding the intervals between endoscopic surveillance sessions.

Adenocarcinoma↗
PubMed2002

Quality of colonoscopy reporting: a process of care study.

OBJECTIVE: Several groups have developed guidelines for specific content necessary in endoscopic procedure reports. Little information is available assessing adherence to reporting recommendations, and little is known about common reporting errors. The aim of this study was to assess the quality of colonoscopy reporting and to identify possible areas of improvement. METHODS: Using the 1997 American Society for GI Endoscopy guidelines for endoscopy reporting, we created operational definitions for adherence to each guideline. We then created 31 specific process of care criteria to assess adherence to each of these operational definitions. We subdivided the 31 specific process of care criteria into six domains: demographic information, patient history, sedation procedure, adequacy of preparation/visibility, lesion identification/removal, and procedure interpretation. Reports obtained from 122 separate endoscopy centers were reviewed for adherence to the guidelines. Adequate performance for any criterion was defined as 70% or better compliance. RESULTS: Performance varied widely across the domains. Clinicians demonstrated adequate performance on sedation procedure (75%) and lesion identification/removal (84%). Clinicians scored poorly on demographic data (69%), patient history (57%), procedure quality (40%), and procedure interpretation (58%). CONCLUSIONS: Clinicians' colonoscopy reporting practices are widely variable and often suboptimal. There is an opportunity to improve the quality of care in colonoscopy reporting by improving physicians' adherence to established standards.

Colonoscopy↗
PubMed2002

Resection of benign esophageal stricture through a minimally invasive endoscopic and transgastric approach.

Recurrent benign esophageal strictures that are refractory to dilation can be difficult to manage. We report a novel technique for treatment of a recurrent esophageal stricture using a minimally invasive endoscopic and transgastric approach. The patient is a 40-year-old women who developed a recurrent distal esophageal stricture after repair of an esophageal perforation. Multiple prior dilations had been unsuccessful in achieving sustained esophageal patency, and the patient presented with a complete distal obstruction demonstrated on barium esophagram. Two flexible endoscopes were used: one placed through the mouth and another through a gastrostomy. While the transilluminated lesion was visualized from below the obstruction was traversed with an endoscopic aspiration needle from above. A guidewire was placed through the needle and pulled out the gastrostomy. Both the esophageal lesion and the gastrostomy tract were then serially dilated over the wire. After dilation the residual stricture was resected using a circular stapler placed through the dilated gastrostomy tract. After this procedure the patient maintained esophageal patency with a diminished need for dilation. Details of our technique are described and the literature is reviewed.

Adult↗