Wahid Wassef
University of Massachusetts Medical School, Internal Medicine, Faculty Member
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Natural orifice transluminal endoscopic surgery is a new therapeutic procedure that combines surgical and endoscopic skills. Although not currently widely used, it is gaining momentum both in the animal laboratory and in human case... more
Natural orifice transluminal endoscopic surgery is a new therapeutic procedure that combines surgical and endoscopic skills. Although not currently widely used, it is gaining momentum both in the animal laboratory and in human case reports. To date, 15 procedures have been successfully performed on humans worldwide. These included appendectomies (eight), liver biopsies (three), tubal ligation (one), and cholecystectomies (three). Numerous other procedures, using hybrid techniques that combine natural orifice transluminal endoscopic surgery technology with alternative conventional laparoscopic techniques, have been described in human clinical trials. In this review, we will discuss the potential benefits of this procedure over conventional surgical interventions, briefly review the major challenges to the technique (access, spatial orientation, anastomosis, and closure), and point out the technological limitations that severely handicap its potential. Despite the widespread interest in this technology, there are a lot of shortcomings: limitations in equipment, lack of clinical outcome data, and absence of randomized trials that compare it with alternative conventional surgical interventions. Nevertheless, it is crucial to remember that we have just started the evaluation process for this new exiting technology, and that, clearly, the best is yet to come.
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Natural orifice transluminal endoscopic surgery is a new therapeutic procedure that combines surgical and endoscopic skills. Although not currently widely used, it is gaining momentum both in the animal laboratory and in human case... more
Natural orifice transluminal endoscopic surgery is a new therapeutic procedure that combines surgical and endoscopic skills. Although not currently widely used, it is gaining momentum both in the animal laboratory and in human case reports. To date, 15 procedures have been successfully performed on humans worldwide. These included appendectomies (eight), liver biopsies (three), tubal ligation (one), and cholecystectomies (three). Numerous other procedures, using hybrid techniques that combine natural orifice transluminal endoscopic surgery technology with alternative conventional laparoscopic techniques, have been described in human clinical trials. In this review, we will discuss the potential benefits of this procedure over conventional surgical interventions, briefly review the major challenges to the technique (access, spatial orientation, anastomosis, and closure), and point out the technological limitations that severely handicap its potential. Despite the widespread interest in this technology, there are a lot of shortcomings: limitations in equipment, lack of clinical outcome data, and absence of randomized trials that compare it with alternative conventional surgical interventions. Nevertheless, it is crucial to remember that we have just started the evaluation process for this new exiting technology, and that, clearly, the best is yet to come.
Research Interests:
The advent of new endoscopic optical techniques is likely to change pathologists' role in diagnosis. To describe how confocal laser... more
The advent of new endoscopic optical techniques is likely to change pathologists' role in diagnosis. To describe how confocal laser endomicroscopy (CLE) works, show its advantages and limitations compared to cytohistologic biopsy, and explore how it may affect the practice of pathology. Literature review. Confocal laser endomicroscopy is proving its ability to provide histology-like images of tissues in vivo to help avoid risks and costs of conventional biopsies. Confocal imaging restricts light to 1 plane, emulating a paraffin section, and topical or systemic optical contrast agents allow subcellular resolution. New contrast agents could theoretically permit molecular characterization. In vivo imaging has begun to demonstrate novel, dynamic types of diagnostic features. Decreased histologic biopsies can be anticipated for a few scenarios. Significant limitations of CLE include the inability to create a tissue archive for broad molecular classification, suboptimal contrast agents, small fields of view and shallow penetration, paucity of clinical validation studies, and problems with reimbursement. Confocal laser endomicroscopy exposes new opportunities for pathologists: CLE technologies can be exploited in pathology, and diagnostic criteria expanded based on endoscopists' discoveries. Potential synergy exists between CLE and cytology, allowing the low-magnification diagnostic architectural changes by CLE and cytomorphology to emulate the full diagnostic information in a histologic biopsy while providing an archive of material for molecular or immunohistochemical studies. Confocal laser endomicroscopy will decrease some types of biopsies, but offers an opportunity for pathologists to find new ways to provide value and improve patient care.
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Pain in patients with chronic pancreatitis (CP) remains the primary clinical complaint and source of poor quality of life. However, clear guidance on evaluation and treatment is lacking. Pancreatic Pain working groups reviewed information... more
Pain in patients with chronic pancreatitis (CP) remains the primary clinical complaint and source of poor quality of life. However, clear guidance on evaluation and treatment is lacking. Pancreatic Pain working groups reviewed information on pain mechanisms, clinical pain assessment and pain treatment in CP. Levels of evidence were assigned using the Oxford system, and consensus was based on GRADE. A consensus meeting was held during PancreasFest 2012 with substantial post-meeting discussion, debate, and manuscript refinement. Twelve discussion questions and proposed guidance statements were presented. Conference participates concluded: Disease Mechanism: Pain etiology is multifactorial, but data are lacking to effectively link symptoms with pathologic feature and molecular subtypes. Assessment of Pain: Pain should be assessed at each clinical visit, but evidence to support an optimal approach to assessing pain character, frequency and severity is lacking. There was general agreement on the roles for endoscopic and surgical therapies, but less agreement on optimal patient selection for medical, psychological, endoscopic, surgical and other therapies. Progress is occurring in pain biology and treatment options, but pain in patients with CP remains a major problem that is inadequately understood, measured and managed. The growing body of information needs to be translated into more effective clinical care.
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An international symposium entitled "Acute pancreatitis: progress and challenges" was held on November 5, 2014 at the Hapuna Beach Hotel, Big Island, Hawaii, as part of the 45th Anniversary Meeting of the American Pancreatic... more
An international symposium entitled "Acute pancreatitis: progress and challenges" was held on November 5, 2014 at the Hapuna Beach Hotel, Big Island, Hawaii, as part of the 45th Anniversary Meeting of the American Pancreatic Association and the Japanese Pancreas Society. The course was organized and directed by Drs. Stephen Pandol, Tooru Shimosegawa, Robert Sutton, Bechien Wu, and Santhi Swaroop Vege. The symposium objectives were to: (1) highlight current issues in management of acute pancreatitis, (2) discuss promising treatments, (3) consider development of quality indicators and improved measures of disease activity, and (4) present a framework for international collaboration for development of new therapies. This article represents a compilation and adaptation of brief summaries prepared by speakers at the symposium with the purpose of broadly disseminating information and initiatives.
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The needs placed on today's physician to improve efficiency in the endoscopy unit are nowhere more apparent than in transcribing endoscopy reports. In spite of the constant progress made in currently available electronic endoscopy... more
The needs placed on today's physician to improve efficiency in the endoscopy unit are nowhere more apparent than in transcribing endoscopy reports. In spite of the constant progress made in currently available electronic endoscopy information systems, the systems lack efficiency and ease of use. Both of these problems could be addressed through the linkage of electronic endoscopy information systems to currently available accessory systems. W review how the linkage of tablet personal computers, voice recognition systems, and web connectivity software, which facilitates communication with electronic-based medical records, can be helpful. The final answer, however, will have to await clinical trials.
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Background: Lymphoepithelial cysts (LEC) of the pancreas are very rare with only 65 reported cases in the literature. Many of the cases are found at the time of exploratory laporotomy. ... To read this article in full you may need to log... more
Background: Lymphoepithelial cysts (LEC) of the pancreas are very rare with only 65 reported cases in the literature. Many of the cases are found at the time of exploratory laporotomy. ... To read this article in full you may need to log in, make a payment or gain access through a ...
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To develop a mechanism of discovering misdirection into the airway of naso/orogastric tubes before they reach their full depth of placement in adults. After a preliminary proof of concept animal study suggested the safety and feasibility... more
To develop a mechanism of discovering misdirection into the airway of naso/orogastric tubes before they reach their full depth of placement in adults. After a preliminary proof of concept animal study suggested the safety and feasibility of assessing tracheal or esophageal intubation with a self inflating bulb syringe, a prospective, observational study was performed in humans evaluating both the bulb syringe and a colorimetric CO2 detector. Medical ICUs of a tertiary care medical center. 202 medical adult ICU patients whose bedside caregivers had determined a need for placement of a naso/orogastric tube. Measurement of reinflation of the self inflating bulb syringe and color change on the colorimetric CO2 detector when the tube was positioned at 30 cm. We compared these findings to a "standard" (i.e. end tidal CO2 results of a capnograph and the results of a chest radiograph performed at the completion of the tube placement). A prospective convenience sample of 257 tube p...
Research Interests: Colorimetry, Carbon Dioxide, Prospective studies, Humans, Female, and 14 moreAnimals, Male, Behavioral Animal Models, Clinical Sciences, Middle Aged, Respiratory System, Swine, Cost Benefit Analysis, Chest, Intensive Care Units, Sensitivity and Specificity, Capnography, Critical Illness, and syringes
Background: The evaluation of a patient with chronic abdominal pain can be difficult given the broad differential diagnosis. Iatrogenic causes such as the adverse effects of medications need to be considered. ... To read this article in... more
Background: The evaluation of a patient with chronic abdominal pain can be difficult given the broad differential diagnosis. Iatrogenic causes such as the adverse effects of medications need to be considered. ... To read this article in full you may need to log in, make a payment or ...
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ANALYTIC REVIEWS Variceal Bleeding: Prophylaxis, Treatment, and Prevention Khoa Do, MD, Wahid Wassef, MD, FACG, and Kanishka Bhattacharya, MD Do K, Wassef W, Bhattacharya K. Variceal bleeding: prophylaxis, Variceal hemorrhage is a prime... more
ANALYTIC REVIEWS Variceal Bleeding: Prophylaxis, Treatment, and Prevention Khoa Do, MD, Wahid Wassef, MD, FACG, and Kanishka Bhattacharya, MD Do K, Wassef W, Bhattacharya K. Variceal bleeding: prophylaxis, Variceal hemorrhage is a prime complication of por-...
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... Medical device evaluation by the Food and Drug Administration (FDA). Nelson DB, Block KP, Bosco JJ, Burdick JS, Curtis WD, Faigel DO, Greenwald DA, Kelsey PB, Rajan E, Slivka A, Smith P, VanDam J, Wassef W, Wang KK; American Society... more
... Medical device evaluation by the Food and Drug Administration (FDA). Nelson DB, Block KP, Bosco JJ, Burdick JS, Curtis WD, Faigel DO, Greenwald DA, Kelsey PB, Rajan E, Slivka A, Smith P, VanDam J, Wassef W, Wang KK; American Society for Gastrointestinal Endoscopy. ...
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1. Gastrointest Endosc. 2006 Mar;63(3):527-9. Metastatic Merkel cell carcinoma diagnosed by EUS-guided FNA of a rapidly progressive peripancreatic mass. Jessup TP, Wassef WY, Yantiss RK, Bhattacharya K. Divisions of ...
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Gastrointestinal Endoscopy, Volume 69, Issue 3, Pages 399-407, March 2009, Authors: Prepared by: ASGE TECHNOLOGY COMMITTEE; Richard S. Kwon, MD; Douglas G. Adler, MD; Bipan Chand, MD; Jason D. Conway, MD; David L. Diehl, MD; Sergey V.... more
Gastrointestinal Endoscopy, Volume 69, Issue 3, Pages 399-407, March 2009, Authors: Prepared by: ASGE TECHNOLOGY COMMITTEE; Richard S. Kwon, MD; Douglas G. Adler, MD; Bipan Chand, MD; Jason D. Conway, MD; David L. Diehl, MD; Sergey V. Kantsevoy, MD; Petar ...
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Training future endoscopists is essential to meeting the increasing demands for colonoscopy. It remains unknown whether adenoma detection rates are adversely affected by trainee participation. This is a single-center, prospective study.... more
Training future endoscopists is essential to meeting the increasing demands for colonoscopy. It remains unknown whether adenoma detection rates are adversely affected by trainee participation. This is a single-center, prospective study. The primary aim of this study was to investigate whether adenoma detection rates differed between procedures with or without trainee involvement. A total of 368 consecutive patients entered the analysis (181 with trainee participation and 187 without). Adenomas were detected in 19.3% of experienced physician-only procedures and in 14.9% of procedures with trainee participation. Advanced adenomas were detected in 8.6% of experienced physicians' procedures vs. 4.9% of trainee procedures. Polyp detection was nearly identical in both groups (32% for experienced physicians; 33% for trainees). Trainee participation delayed the procedure by a mean of seven minutes. Adenoma detection rates did not differ significantly, whether there was trainee involvement or not. A trend toward finding more adenomas or advanced adenomas in the absence of a trainee was observed, but it was lower than previously reported interobserver variability among experienced physicians. The small difference in adenoma detection was not observed for polyp detection, which may be explained by the more frequent removal of hyperplastic polyps by trainees.