Publications by authors named "Shashin Shah"

9 Publications

  • Page 1 of 1

Balloon Extraction of an Intraductal Tubulopapillary Neoplasm of the Bile Duct During Endoscopic Retrograde Cholangiopancreatography.

ACG Case Rep J 2020 Nov 24;7(11):e00481. Epub 2020 Nov 24.

Division of Gastroenterology and Hepatology, Department of Medicine, Lehigh Valley Health Network, Allentown, PA.

Intraductal tubulopapillary neoplasm (ITPN) of the bile duct is a rare type of intraductal neoplasm of the bile duct that has mainly been described in the literature in case reports and small case series. Only within the past decade has ITPN of the bile duct been identified as its own entity and have definitive diagnostic criteria been established. Given its rarity, there is no standard of care for treatment. Here, we describe a case report of biliary ITPN diagnosed in a unique manner.
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http://dx.doi.org/10.14309/crj.0000000000000481DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7685965PMC
November 2020

A prospective, head-to-head comparison of 2 EUS-guided liver biopsy needles in vivo.

Gastrointest Endosc 2021 May 9;93(5):1133-1138. Epub 2020 Oct 9.

Department of Gastroenterology, Lehigh Valley Health Network, Allentown, Pennsylvania, USA.

Background And Aims: Procedural standardization in endoscopic ultrasound-guided liver biopsy (EUS-LB) is necessary to obtain core biopsy specimens for accurate diagnosis. The objective of this study was to directly compare the diagnostic yield of 2 EUS-LB fine-needle biopsy (FNB) systems in vivo.

Methods: In this prospective, single-center study, 108 adult patients undergoing EUS-LB over a 1-year period were included. Each EUS-LB consisted of an EGD, followed by EUS-guided biopsy of the left lobe of the liver sequentially using 2 different 19-gauge needles: the fork-tip (SharkCore) and Franseen (Acquire) FNB systems. Specimens were then reviewed by a GI histopathologist to determine diagnostic adequacy as well as the number of complete portal tracts, specimen length, and degree of fragmentation.

Results: In 79.4% of cases, the fork-tip FNB system yielded a final diagnosis compared with 97.2% of the Franseen FNB specimens (P < .001). The mean number of complete portal tracts in the fork-tip FNB samples was 7.07 compared with 9.59 in the Franseen FNB samples (P < .001). The mean specimen length was 13.86 mm for the fork-tip FNB and 15.81 mm for the Franseen FNB (P = .004). Cores were intact in 47.6% of the fork-tip FNB samples and in 75.2% of the Franseen FNB samples (P = .004).

Conclusions: In EUS-LB, we found that the 19-gauge Franseen FNB system resulted in a statistically significant increase in diagnostic adequacy compared with biopsy using the fork-tip FNB system.
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http://dx.doi.org/10.1016/j.gie.2020.09.050DOI Listing
May 2021

Complications Related to Esophageal Stent (Boston Scientific Wallflex vs. Merit Medical Endotek) Use in Benign and Malignant Conditions.

Cureus 2020 Mar 23;12(3):e7380. Epub 2020 Mar 23.

Public Health, Lehigh Valley Health Network, Allentown, USA.

Background In our institutions, there are two types of stents used: the Boston Scientific Wallflex (Marlborough, Massachusetts) and Merit Medical Endotek (South Jordan, Utah). So we performed this retrospective study to compare complication rates in various esophageal disorders to improve our quality of care. Methods Charts were reviewed to capture gender, indications of stent placement, stent length/diameter, age of the patient at the time of stent placement, length of hospital stay, physicians performing a procedure, and complications within 90 days of stent placement. Results A total of 67 patients (71.6% male) underwent stent placement (WallFlex 49.3% and Merit 50.8%) for malignant (68.7%) mainly esophageal obstruction by primary esophageal cancer (89.1%) and benign causes (31.3%) mainly esophageal leak (66.7%). Merit and WallFlex used in malignant conditions were 82.4% and 54.6%, respectively, and in benign conditions, they were 17.7% and 45.5%, respectively. The mean age at which endoscopy was performed was 64. Complications post Merit and WallFlex placement were 79.4% and 60.6%, respectively. Complications with malignant and benign conditions were 73.9% and 61.9%, respectively. Complications with 19, 18, and 23 mm diameters were 75.0%, 66.7%, and 69.4%, respectively. Complications with 120, 150, 100, 15, 12, 10 mm stent lengths were 84.6%, 58.3%, 58.8%, 80.0%, 75.0%, and 33.3%, respectively. Conclusion Our study showed that the Merit stent was mainly used, and the major indication of stent placement was a malignant condition. Major complications were seen when the reason for stent placement was a malignant condition, the diameter was 19 mm, the length was 120 mm, and the use of the Merit stent.
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http://dx.doi.org/10.7759/cureus.7380DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7176327PMC
March 2020

Triple Pancreatic Walled-off Fluid Collections Treated Simultaneously with Endoscopic Transmural Drainage.

Cureus 2018 Jan 9;10(1):e2047. Epub 2018 Jan 9.

Gastroenterology, Lehigh valley health network.

Pancreatic pseudocysts and walled-off pancreatic necrosis arise as a complication of pancreatitis. Multiple fluid collections are seen in 5-20% of the patients who have walled-off peripancreatic fluid collections. There is a paucity of data regarding the role of endoscopic transmural drainage in the management of multiple pancreatic fluid collections. In this case report, we present the case of a 72-year-old male with three walled-off pancreatic fluid collections in the setting of acute necrotizing pancreatitis. The patient underwent simultaneous endoscopic ultrasound-assisted cyst gastrostomy and cyst duodenostomy and aggressive irrigation without index endoscopic necrosectomy of the three peripancreatic fluid collections. Significant improvement in the size of the fluid collections was seen on the computed tomography scan, as well as a remarkable immediate clinical improvement after 24 hours of the endoscopic intervention.
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http://dx.doi.org/10.7759/cureus.2047DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5844594PMC
January 2018

Agreement between endoscopic ultrasound-guided fine-needle aspiration and endobiliary brush cytology in suspected pancreaticobiliary malignancies.

Endosc Int Open 2017 Dec 6;5(12):E1251-E1258. Epub 2017 Dec 6.

Department of Medicine, Division of Gastroenterology and Hepatology, Lehigh Valley Health Network, Allentown, Pennsylvania, United States.

Background And Study Aims:  For suspected pancreaticobiliary malignancies, endobiliary brush cytology during endoscopic retrograde cholangiopancreatography (ERCP) remains the diagnostic test of choice despite historically poor and variable sensitivity. This has led to increased use of endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) as an initial test. Recently, our institution began using a cytology brush that was designed specifically to collect a more substantial and higher-quality sample. The aim of this study was to investigate whether this brush design would provide more adequate samples and have high agreement with EUS-FNA in patients who underwent both procedures.

Patients And Methods:  A retrospective chart review was conducted of all patients who underwent both EUS-FNA and endobiliary brush cytology for suspicion of pancreaticobiliary malignancy from January 2013 to May 2015. A total of 41 patients met the inclusion criteria. Initially, sample quality was evaluated. Final cytology results were then assessed for agreement with EUS-FNA using Cohen's kappa. The effect of considering atypical cytology as negative was also uniquely evaluated by running separate analyses.

Results:  Brush cytology provided an adequate sample in 95.1 % of cases. Cohen's Kappa demonstrated moderate agreement between brush cytology and EUS-FNA: κ = 0.42 (  = 0.001). When atypical results were excluded, agreement increased: κ = 0.60 (  = 0.02), but remained moderate. If atypical results were considered "positive," the two procedures demonstrated equal cancer detection rates of 80.8 %.

Conclusions:  The studied brush provided more adequate samples compared with historical rates for brush cytology and had moderate agreement with EUS-FNA. If this brush truly increases sample adequacy, it could potentially provide results comparable to EUS-FNA at lower cost.
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http://dx.doi.org/10.1055/s-0043-119754DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5718904PMC
December 2017

Initial experience with a novel EUS-guided core biopsy needle (SharkCore): results of a large North American multicenter study.

Endosc Int Open 2016 Sep 30;4(9):E974-9. Epub 2016 Aug 30.

Brigham and Women's Hospital, Boston, Massachusetts, United States.

Background And Aims: The ability to safely and effectively obtain sufficient tissue for pathologic evaluation by using endoscopic ultrasound (EUS) guidance remains a challenge. Novel designs in EUS needles may provide for improved ability to obtain such core biopsies. The aim of this study was to evaluate the diagnostic yield of core biopsy specimens obtained using a novel EUS needle specifically designed to obtain core biopsies.

Patients And Methods: Multicenter retrospective review of all EUS-guided fine-needle biopsies obtained using a novel biopsy needle (SharkCore FNB needle, Medtronic, Dublin, Ireland). Data regarding patient demographics, lesion type/location, technical parameters, and diagnostic yield was obtained.

Results: A total of 250 lesions were biopsied in 226 patients (Median age 66 years; 113 (50 %) male). Median size of all lesions (mm): 26 (2 - 150). Overall, a cytologic diagnosis was rendered in 81 % specimens with a median number of 3 passes. When rapid onsite cytologic evaluation (ROSE) was used, cytologic diagnostic yield was 126/149 (85 %) with a median number of 3 passes; without ROSE, cytologic diagnostic yield was 31/45 (69 %, P = 0.03) with a median number of 3 passes. Overall, a pathologic diagnosis was rendered in 130/147 (88 %) specimens with a median number of 2 passes. Pathologic diagnostic yield for specific lesion types: pancreas 70/81 (86 %), subepithelial lesion 13/15 (87 %), lymph node 26/28 (93 %). Ten patients (10/226, 4 %) experienced adverse events: 4 acute pancreatitis, 5 pain, 1 fever/cholangitis.

Conclusions: Initial experience with a novel EUS core biopsy needle demonstrates excellent pathologic diagnostic yield with a minimum number of passes.
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http://dx.doi.org/10.1055/s-0042-112581DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5025313PMC
September 2016

Is there any difference in outcomes between long pigtail and short flanged prophylactic pancreatic duct stents?

Dig Dis Sci 2011 Jan 13;56(1):260-5. Epub 2010 May 13.

Department of Medicine, Division of Gastroenterology, Long Island Jewish Medical Center, 270-05 76th Avenue, New Hyde Park, NY 11040, USA.

Objective: Prophylactic pancreatic duct (PD) stent placement has been shown to reduce the incidence of post-ERCP pancreatitis (PEP) especially in high-risk patients. However, there is no consensus on the best type of PD stent. The purpose of our study was to evaluate the differences in the outcomes between long (>3 cm) pigtail and short (≤3 cm) flanged 4 Fr Freeman Pancreatic Flexi-Stents in preventing PEP.

Methods: We retrospectively reviewed all ERCP procedures performed between 08/01/2006 and 10/01/2007 by one of two experienced endoscopists (>5 years of experience) with the assistance of a trainee. Patient data was collected for indications, risk factors for PEP, type and reason for PD stent, complications, and any mortality. The PD stent was removed endoscopically if it was still in place on abdominal X-ray done 2 weeks post-ERCP. The data was analyzed with Student's t test, Chi-square, and ANOVA tests by using SPSS software version 15.0.

Results: Out of a total of 753 ERCP procedures, 179 (23.8%) required either long or short prophylactic PD stents. The incidence of PEP was 3.7% versus 13.6% for long and short stent groups, respectively (p=0.019). Spontaneous stent dislodgement rate was 95.4% versus 81.8% for long and short stent groups, respectively (p=0.007). There was no difference in non-pancreatic complications between the two stent groups. There was no procedure-related mortality.

Conclusions: Long (>3 cm) pigtail PD stent due to their specific design showed better outcomes as compared to short (<3 cm) flanged PD stent in preventing PEP and spontaneous stent dislodgement rates. However, further prospective trials are needed.
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http://dx.doi.org/10.1007/s10620-010-1262-xDOI Listing
January 2011

Sterically encumbered diphosphaalkenes and a bis(diphosphene) as potential multiredox-active molecular switches: EPR and DFT investigations.

Inorg Chem 2003 Oct;42(20):6241-51

Department of Physical Chemistry, University of Geneva, 30 Quai E. Ansermet, 1211 Geneva 4, Switzerland.

The reduction products of two diphosphaalkenes (1 and 2) and a bis(diphosphene) (3) containing sterically encumbered ligands and corresponding to the general formulas Ar-X=Y-Ar'-Y=X-Ar, have been investigated by EPR spectroscopy. Due to steric constraints in these molecules, at least one of the dihedral angles between the CXYC plane and either the Ar plane or the Ar' plane is largely nonzero and, hence, discourages conformations that are optimal for maximal conjugation of P=X (or P=Y) and aromatic pi systems. Comparison of the experimental hyperfine couplings with those calculated by DFT on model systems containing no cumbersome substituents bound to the aromatic rings shows that addition of an electron to the nonplanar neutral systems causes the X=Y-Ar'-Y=X moiety to become planar. In contrast to 1 and 2, 3 can be reduced to relatively stable dianion. Surprisingly the two-electron reduction product of 3 is paramagnetic. Interpretation of its EPR spectra, in the light of DFT calculations on model dianions, shows that in [3](2)(-) the plane of the Ar' ring is perpendicular to the CXYC planes. Due to interplay between steric and electronic preferences, the Ar-X=Y-Ar'-Y=X-Ar array for 3 is therefore dependent upon its redox state and acts as a "molecular switch".
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http://dx.doi.org/10.1021/ic030079jDOI Listing
October 2003

An unusual equilibrium chlorine atom transfer process and its potential for assessment of steric pressure by bulky aryls.

J Am Chem Soc 2003 Jan;125(1):40-1

Department of Chemistry, Case Western Reserve University, 10900 Euclid Avenue, Cleveland, OH 44106-7078, USA.

An unusually facile intermolecular chlorine atom transfer process has been discovered between the phospha-Wittig reagents ArP=PMe3 and ArPCl2 (Ar is a sterically hindered aryl group). The atom transfer process is catalyzed by added PMe3. A mechanism is forwarded that is based upon a Me3P/Me3PCl2 couple that allows shuttling of chlorine atoms between ArP groups. This unique transfer process is exploited to evaluate the steric properties of aryl groups via an equilibrium process.
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http://dx.doi.org/10.1021/ja028422rDOI Listing
January 2003