450 results on '"Tiing Leong ANG"'
Search Results
2. Clinical Features and Predictors of Dysplasia in Proximal Sessile Serrated Lesions
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Yi Yuan Tan, Gary Sei Kiat Tay, Yu Jun Wong, James Weiquan Li, Andrew Boon Eu Kwek, Tiing Leong Ang, Lai Mun Wang, and Malcolm Teck Kiang Tan
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dysplasia ,large ,prevalence ,proximal ,sessile serrated lesion ,Internal medicine ,RC31-1245 ,Diseases of the digestive system. Gastroenterology ,RC799-869 - Abstract
Background/Aims Proximal colorectal cancers (CRCs) account for up to half of CRCs. Sessile serrated lesions (SSLs) are precursors to CRC. Proximal location and presence of dysplasia in SSLs predict higher risks of progression to cancer. The prevalence of dysplasia in proximal SSLs (pSSLs) and clinical characteristics of dysplastic pSSLs are not well studied. Methods Endoscopically resected colonic polyps at our center between January 2016 and December 2017 were screened for pSSLs. Data of patients with at least one pSSL were retrieved and clinicopathological features of pSSLs were analysed. pSSLs with and without dysplasia were compared for associations. Results Ninety pSSLs were identified, 45 of which had dysplasia giving a prevalence of 50.0%. Older age (65.9 years vs. 60.1 years, p=0.034) was associated with the presence of dysplasia. Twelve pSSLs were 10 mm or larger. After adjusting for age, pSSLs ≥10 mm had an adjusted odds ratio of 5.98 (95% confidence interval, 1.21–29.6) of having dysplasia compared with smaller pSSLs. Conclusions In our cohort of pSSLs, the prevalence of dysplasia is high at 50.0% and is associated with lesion size ≥10 mm. Endoscopic resection for all proximal serrated lesions should be en bloc to facilitate accurate histopathological examination for dysplasia as its presence warrants shorter surveillance intervals.
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- 2021
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3. Favorable vaccine-induced SARS-CoV-2–specific T cell response profile in patients undergoing immune-modifying therapies
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Martin Qui, Nina Le Bert, Webber Pak Wo Chan, Malcolm Tan, Shou Kit Hang, Smrithi Hariharaputran, Jean Xiang Ying Sim, Jenny Guek Hong Low, Weiling Ng, Wei Yee Wan, Tiing Leong Ang, Antonio Bertoletti, and Ennaliza Salazar
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COVID-19 ,Immunology ,Medicine - Abstract
BACKGROUND Patients undergoing immune-modifying therapies demonstrate a reduced humoral response after COVID-19 vaccination, but we lack a proper evaluation of the effect of such therapies on vaccine-induced T cell responses.METHODS We longitudinally characterized humoral and spike-specific T cell responses in patients with inflammatory bowel disease (IBD), who were on antimetabolite therapy (azathioprine or methotrexate), TNF inhibitors, and/or other biologic treatment (anti-integrin or anti-p40) for up to 6 months after completing 2-dose COVID-19 mRNA vaccination.RESULTS We demonstrate that a spike-specific T cell response was not only induced in treated patients with IBD at levels similar to those of healthy individuals, but also sustained at higher magnitude for up to 6 months after vaccination, particularly in those treated with TNF inhibitor therapy. Furthermore, the spike-specific T cell response in these patients was mainly preserved against mutations present in SARS-CoV-2 B.1.1.529 (Omicron) and characterized by a Th1/IL-10 cytokine profile.CONCLUSION Despite the humoral response defects, patients under immune-modifying therapies demonstrated a favorable profile of vaccine-induced T cell responses that might still provide a layer of COVID-19 protection.FUNDING This study was funded by the National Centre for Infectious Diseases (NCID) Catalyst Grant (FY2021ES) and the National Research Fund Competitive Research Programme (NRF-CRP25-2020-0003).
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- 2022
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4. Helicobacter pylori Treatment Strategies in Singapore
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Tiing Leong Ang and Daphne Ang
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helicobacter pylori ,eradication ,antibiotic resistance ,Diseases of the digestive system. Gastroenterology ,RC799-869 - Abstract
The management of Helicobacter pylori infection in Singapore remains a clinical challenge. Similar to other regions, there has been an increase in antibiotic resistance rates through the years. Nonetheless, over the past two decades, clarithromycin-based triple therapy has continued to be used as the first line treatment option, with an eradication rate exceeding 90%, although the accepted treatment duration must now be lengthened from 1 to 2 weeks to maintain efficacy. Concomitant and sequential therapies did not demonstrate superiority over standard triple therapy. Current empiric second line treatment utilizes either bismuth-based quadruple therapy or levofloxacin-based triple therapy, but outcomes remain less than ideal. Identifying options to further improve treatment success rates is challenging. Strategies being considered include the use of potent acid suppressants, such as vonoprazan, and H. pylori culture and antibiotic susceptibility testing-guided therapy.
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- 2021
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5. A systematic review and meta-analysis of the COVID-19 associated liver injury
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Yu Jun Wong, Malcolm Tan, Qishi Zheng, James Weiquan Li, Rahul Kumar, Kwong Ming Fock, Eng Kiong Teo, and Tiing Leong Ang
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SARS-CoV-2 infection ,Liver Disease ,Alanine Transaminase ,Aspartate Aminotransferases ,Specialties of internal medicine ,RC581-951 - Abstract
Introduction and Objectives: The novel coronavirus disease 2019 (COVID-19) has affected more than 5 million people globally. Data on the prevalence and degree of COVID-19 associated liver injury among patients with COVID-19 remain limited. We conducted a systematic review and meta-analysis to assess the prevalence and degree of liver injury between patients with severe and non-severe COVID-19. Methods: We performed a systematic search of three electronic databases (PubMed/MEDLINE, EMBASE and Cochrane Library), from inception to 24th April 2020. We included all adult human studies (>20 subjects) regardless of language, region or publication date or status. We assessed the pooled odds ratio (OR), mean difference (MD) and 95% confidence interval (95%CI) using the random-effects model. Results: Among 1543 citations, there were 24 studies (5961 subjects) which fulfilled our inclusion criteria. The pooled odds ratio for elevated ALT (OR = 2.5, 95%CI: 1.6-3.7, I2 = 57%), AST (OR = 3.4, 95%CI: 2.3-5.0, I2 = 56%), hyperbilirubinemia (OR = 1.7, 95%CI: 1.2-2.5, I2 = 0%) and hypoalbuminemia (OR = 7.1, 95%CI: 2.1-24.1, I2 = 71%) were higher subjects in critical COVID-19. Conclusion: COVID-19 associated liver injury is more common in severe COVID-19 than non-severe COVID-19. Physicians should be aware of possible progression to severe disease in subjects with COVID-19-associated liver injury.
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- 2020
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6. Mesenteric panniculitis does not confer an increased risk for cancers
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Ikram Hussain, MBBS, MRCP, Saba Ishrat, MBBS, FRCS, Veeraraghavan Meyyur Aravamudan, MBBS, MRCP, Shahab R. Khan, MBBS, Babu P. Mohan, MD, Rahul Lohan, MBBS, FRCR, Muhammad Bilal Abid, MD, MRCP, Tiing Leong Ang, MBBS, FRCP, and Wen-Wei Sung.
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Medicine - Abstract
Abstract. Background:. Mesenteric panniculitis (MP) is a non-specific, localized inflammation at the mesentery of small intestines which often gets detected on computed tomography. An association with malignant neoplasms remains unclear. We performed a systematic review and meta-analysis to examine the association of malignancy with MP. Methods:. MEDLINE, EMBASE, Web of Science, and Cochrane databases were searched for articles published from inception to 2020 that evaluated the association of malignant neoplasms with MP in comparison with control groups. Using random-effects method, a summary odds ratio (OR) estimate with 95% confidence intervals for malignant neoplasms in MP was estimated. Results:. Four case-control studies reporting data on 415 MP patients against 1132 matched-controls met inclusion criteria and were analyzed. The pooled OR for finding a malignant neoplasm in patients with MP was 0.907 (95% CI: 0.688–1.196; P = .489). The heterogeneity was mild and non-significant. Also, there was no heightened risk of any specific type of malignancy with MP. Three more case-series with unmatched-control groups (MP: 282, unmatched-controls: 17,691) were included in a separate analysis where the pooled OR of finding a malignant neoplasm was 2.963 (95% CI: 1.434–6.121; P = .003). There was substantial heterogeneity in this group. Conclusion:. This meta-analysis of matched controlled studies proves absence of any significant association of malignant neoplasms with MP. Our study also demonstrates that the putative association of malignancy with MP is mainly driven by uncontrolled studies or case-series.
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- 2022
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7. A pilot study to examine the association between human gut microbiota and the host's central obesity
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Seok Hwee Koo, Collins Wenhan Chu, Joan Joo Ching Khoo, Magdalin Cheong, Gaik Hong Soon, Eliza Xin Pei Ho, Ngai Moh Law, Paola Florez De Sessions, Kwong Ming Fock, Tiing Leong Ang, Edmund Jon Deoon Lee, and John Chen Hsiang
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continental population groups ,diet ,metabolic syndrome ,microbiota ,obesity ,Diseases of the digestive system. Gastroenterology ,RC799-869 - Abstract
Background and Aim Perturbance in the composition of human gut microbiota has been associated with metabolic disorders such as obesity, diabetes mellitus, and insulin resistance. The objectives of this study are to examine the effects of ethnicity, central obesity, and recorded dietary components on potentially influencing the human gut microbiome. We hypothesize that these factors have an influence on the composition of the gut microbiome. Methods Subjects of Chinese (n = 14), Malay (n = 10), and Indian (n = 11) ancestry, with a median age of 39 years (range: 22–70 years old), provided stool samples for gut microbiome profiling using 16S rRNA sequencing and completed a dietary questionnaire. The serum samples were assayed for a panel of biomarkers (interleukin‐6, tumor necrosis factor alpha, adiponectin, cleaved cytokeratin 18, lipopolysaccharide‐binding protein, and limulus amebocyte lysate). Central obesity was defined by waist circumference cut‐off values for Asians. Results There were no significant differences in Shannon alpha diversity for ethnicity and central obesity and no associations between levels of inflammatory cytokines and obesity. The relative abundances of Anaerofilum (P = 0.02), Gemellaceae (P = 0.02), Streptococcaceae (P = 0.03), and Rikenellaceae (P = 0.04) were significantly lower in the obese group. From principle coordinate analysis, the effects of the intake of fiber and fat/saturated fat were in contrast with each other, with clustering of obese individuals leaning toward fiber. Conclusion The study demonstrated that there were differences in the gut microbiome in obese individuals. Certain bacterial taxa were present in lower abundance in the group with central obesity. Fiber and fat/saturated fat diets were not the key determinants of central obesity.
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- 2019
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8. Impact of enhanced personal protective equipment on colonoscopy performance during the COVID-19 pandemic
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Kevin Kim Jun Teh, Shu Wen Tay, Kaina Chen, Samantha Jingyun Koh, Yu Jun Wong, Andrew Boon Eu Kwek, James Weiquan Li, Kwong Ming Fock, Eng Kiong Teo, Tiing Leong Ang, and Malcolm Teck Kiang Tan
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Diseases of the digestive system. Gastroenterology ,RC799-869 - Abstract
Background and study aims Using personal protective equipment (PPE) can reduce risk of disease transmission. During the COVID-19 pandemic, enhanced PPE (EPPE) is recommended when performing endoscopy. We aimed to evaluate the impact of EPPE on colonoscopy performance when compared to standard PPE (SPPE). Patients and methods A review of electronic medical records and endoscopy reports of consecutive patients who underwent colonoscopy during two similar one-month time periods (in 2019 and during the COVID-19 pandemic in 2020) was performed. SPPE was used in 2019 and EPPE was used in 2020. Patient clinical data and procedure-related information were captured and analyzed. The primary outcomes were time to cecum (TTC) and total procedure time. Secondary outcomes were adenoma detection rate (ADR), polyp detection rate (PDR) and cecal intubation rate (CIR). Statistical analysis was performed using STATA v16.1. Results Two hundred and forty-seven colonoscopy procedures were analyzed. Baseline demographics and indications for colonoscopy of patients in both groups were similar. There were no significant differences in median TTC (10.0 vs 10.0 min, P = 0.524) or total procedure time (22.5 vs 23.0 min, P = 0.946) between colonoscopy performed in SPPE and EPPE. The ADR, PDR and CIR were also similar. Conclusion Our findings suggest that use of EPPE does not affect colonoscopy performance.
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- 2020
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9. Diagnostic Endoscopic Ultrasound: Technique, Current Status and Future Directions
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Tiing Leong Ang, Andrew Boon Eu Kwek, and Lai Mun Wang
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endosonography ,neoplasm staging ,biopsy ,fine-needle ,Diseases of the digestive system. Gastroenterology ,RC799-869 - Abstract
Endoscopic ultrasound (EUS) is now well established as an important tool in clinical practice. From purely diagnostic imaging, it has progressed to include tissue acquisition, which provided the basis for therapeutic procedures. Even as interventional EUS developed, there has been ongoing progress in EUS diagnostic capabilities due to improved imaging systems, better needles for tissue acquisition and development of enhanced imaging functions such as contrast harmonic EUS (CHEUS) and EUS elastography. EUS is well established for differentiation of subepithelial lesions, for T-staging of luminal gastrointestinal and pancreaticobiliary malignancies, for differentiation of benign pancreaticobiliary disorders and for diagnostic tissue acquisition, which can be achieved by EUS-guided fine needle aspiration or by EUS-guided fine needle biopsy using dedicated biopsy needles. This review briefly describes the technique of performing EUS and then discusses its clinical utility in terms of gastrointestinal cancer staging, the evaluation of pancreaticobiliary disorders and tissue acquisition. Enhanced imaging techniques such as CHEUS and EUS elastography are briefly reviewed.
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- 2018
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10. A prospective randomized study of colonoscopy using blue laser imaging and white light imaging in detection and differentiation of colonic polyps
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Tiing Leong Ang, James Weiquan Li, Yu Jen Wong, Yi-Lyn Jessica Tan, Kwong Ming Fock, Malcolm Teck Kiang Tan, Andrew Boon Eu Kwek, Eng Kiong Teo, Daphne Shih-Wen Ang, and Lai Mun Wang
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Diseases of the digestive system. Gastroenterology ,RC799-869 - Abstract
Background and study aims Published data on blue laser imaging (BLI) for detection and differentiation of colonic polyps are limited compared to narrow band imaging (NBI). This study investigated whether BLI can increase the detection rate of colonic polyps and adenomas when compared to white light imaging (WLI), and examined use of NICE (NBI International Colorectal Endoscopic) and JNET (Japan NBI Expert Team) classifications with BLI. Patients and methods Patients aged 50 years and above referred for colonoscopy were randomized to BLI or WLI on withdrawal. Detected polyps were characterized using NICE and JNET classifications under BLI mode and correlated with histology. Primary outcome was adenoma detection rate. Secondary outcomes were utility of NICE and JNET classifications to predict histology using BLI. Results A total of 182 patients were randomized to BLI (92) or WLI (90). Comparing BLI with WLI, the polyp detection rate was 59.8 % vs 40.0 %, P = 0.008, and the adenoma detection rate was 46.2 % vs 27.8 %, P = 0.010. NICE 1 and JNET 1 diagnosed hyperplastic polyps with sensitivity of 87.18 % and specificity of 84.35 %. NICE 2 diagnosed low- (LGD) or high-grade dysplasia (HGD) with sensitivity of 92.31 % and specificity of 77.45 %. JNET 2A diagnosed LGD with sensitivity of 91.95 %, and specificity of 74.53 %. Four cases of focal HGD all had JNET 2A morphology. Conclusion BLI increased adenoma detection rate compared to WLI. NICE and JNET classifications can be applied when using BLI for endoscopic diagnosis of HP and LGD but histological confirmation remains crucial.
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- 2019
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11. Is endoscopic necrosectomy the way to go?
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James Weiquan Li and Tiing Leong Ang
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Acute necrotising pancreatitis ,Drainage ,Endosonography ,Diseases of the digestive system. Gastroenterology ,RC799-869 - Abstract
Pancreatic necrosis with the formation of walled-off collections is a known complication of severe acute pancreatitis. Infected necrotic pancreatic collections are associated with a high mortality rate. Open necrosectomy and debridement with closed drainage has traditionally been the gold standard for treatment of infected pancreatic necrosis, but carries a high risk of perioperative complications. Direct endoscopic necrosectomy has emerged as a safe and effective modality of treatment for this condition. Careful patient selection and gentle meticulous debridement is important to optimize clinical success. Bleeding is the commonest associated complication with the procedure but most cases can be managed conservatively. Air embolism, although rare, is potentially fatal. The use of fully covered large diameter lumen apposing self-expandable metal stents has further simplified the procedure. These stents optimize drainage, and facilitate endoscopic necrosectomy because repeat insertion of the endoscope into the necrotic cavity can be easily achieved.
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- 2016
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12. A Rare Case of Retrogastric Abscess Occurring Six Months after N-Butyl-2-Cyanoacrylate Injection into Gastric Varices
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Ikram Hussain, Andrew Eu Boon Kwek, Veeraraghavan Meyyur Aravamudan, Chern Hao Chong, and Tiing Leong Ang
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Medicine - Abstract
Background. Injection with N-butyl-2-cyanoacrylate is a proven and successful therapeutic modality for treatment of patients with bleeding gastric varices. However, a variety of complications have also been associated with its use. Here, we report a rare case of retrogastric abscess which occurred almost six months after this therapy. This abscess was attributed to the hampered microbial clearance caused by the venous obliterations from N-butyl-2-cyanoacrylate. The abscess was successfully treated with 3 months of antibiotics.
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- 2018
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13. A prospective randomized study of the difference in diagnostic yield between endoscopic ultrasound-guided fine-needle aspiration (EUSFNA) needles with and without a side port in pancreatic masses
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Tiing Leong Ang, Andrew Boon Eu Kwek, Dong Wan Seo, Woo Hyun Paik, Tsu-Yao Cheng, Hsiu-Po Wang, and James Lau
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Diseases of the digestive system. Gastroenterology ,RC799-869 - Abstract
Background and study aims: Two 22G needles with similar designs, apart from the absence (A) or presence of a side port (B), are available for endoscopic ultrasound (EUS)-guided fine-needle aspiration (FNA). The side port was designed to increase diagnostic yield but this advantage was unproven. This study evaluated the difference in diagnostic yield between both needles in pancreatic masses. Patients and methods: This was a prospective multicenter randomized cross-over study. Patients with pancreatic masses were randomized to one needle for the first two passes, followed by the other for the next two passes. A pathologist blinded to the needle assessed each puncture for cellularity and morphology. The diagnostic yield between both needles was compared. Results: In total, 30 patients were recruited (mean lesion size: 3.5 cm, range: 1.2 – 6.3). Comparison of cellularity adequacy: first pass: A vs. B: 26/30 vs. 24/30 (P = 0.488): 2nd pass: A vs. B: 25/30 vs. 26/30 (P = 0.718). Comparison of diagnostic accuracy: first pass: A vs. B: 22/30 vs. 23/30 (P = 0.766); after two passes: A vs. B: 26/30 vs. 26/30 (P = 1.0). When all four passes were assessed, adequate cellularity was obtained in 29/30 and the correct diagnosis was obtained in 28/30 patients. There were no procedural complications. Conclusions: There was no significant difference in diagnostic yield between EUSFNA needles with or without a side port for pancreatic masses. Study registration: NCT02092519.
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- 2015
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14. EUS-guided insertion of self-expandable metal stent and direct endoscopic necrosectomy in the management of infected walled-off pancreatic necrosis
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Mingjun Song, MD and Tiing Leong Ang, MD
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Diseases of the digestive system. Gastroenterology ,RC799-869 - Published
- 2016
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15. Embolization versus surgery for peptic ulcer bleeding after failed endoscopic hemostasis: a meta-analysis
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Moe Kyaw, Yee Tse, Daphne Ang, Tiing Leong Ang, and James Lau
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Diseases of the digestive system. Gastroenterology ,RC799-869 - Abstract
Background and study aims: A meta-analysis was conducted to assess the efficacy of transcatheter arterial embolization (TAE) compared with surgery in the management of patients with recurrent nonvariceal upper gastrointestinal bleeding (NVUGIB) after failure of endoscopic hemostasis. Patients and methods: Publications in English and non-English literatures (OVID, MEDLINE, and EMBASE) and abstracts from major international conferences were searched for studies comparing TAE with surgery for treatment of NVUGIB after endoscopic hemostasis failure. Outcome measures included rebleeding rate, all-cause mortality rate, and need for additional interventions to secure hemostasis. Results: From 1234 citations, 6 retrospective comparative studies were included that involved 423 patients (TAE, 182, 56 % male; surgery, 241, 68 % male). TAE patients were older (mean age, TAE 75, surgery, 68). The risk of rebleeding was significantly higher in TAE patients compared with surgically treated patients (relative risk [RR] 1.82, 95 % confidence interval [95 %CI] 1.23 – 2.67), with no statistically significant heterogeneity among the included studies (P = 0.66, I 2 = 0.0 %). After sensitivity analysis excluding studies with a large age difference between the two groups, a higher risk of bleeding remained in the TAE group (RR 2.64, 95 %CI] 1.48 – 4.71). No significant difference in mortality (RR 0.87, 95 %CI 0.59 – 1.29) or requirement for additional interventions (RR 1.67, 95 %CI 0.75 – 3.70) was shown between the two groups. Conclusion: A higher rebleeding rate was observed after TAE, suggesting surgery more definitively secured hemostasis, with no significant difference in mortality rate or requirement of additional interventions. The TAE patients were older and in poorer health, thus future randomized studies are needed for accurate comparison of the two modalities.
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- 2014
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16. Endoscopic Ultrasound
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Salem Omar, Manoop S. Bhutani, Kenjiro Yasuda, and Tiing Leong Ang
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Diseases of the digestive system. Gastroenterology ,RC799-869 - Published
- 2013
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17. Current Status of Direct Endoscopic Necrosectomy
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Tiing Leong Ang FRCP (Edin), FAMS (Gastroenterology)
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Medicine - Abstract
The management of pancreatic necrosis has evolved. Sterile necrosis is now managed conservatively. Intervention is generally required for infected necrosis but is now deferred until four weeks after disease onset in order to permit encapsulation and demarcation of the necrotic collection. Demarcation facilitates necrosectomy and reduces complications related to the drainage and debridement procedures. The approach to pancreatic necrosectomy has evolved from primary open necrosectomy to minimally-invasive radiologic, surgical and endoscopic procedures. Direct endoscopic necrosectomy is a minimally-invasive technique that was introduced in recent years for the treatment of infected walled-off necrosis. A stoma is created endoscopically between the gastric lumen and the walled-off collection. An endoscope is then inserted directly into the cavity to perform endoscopic necrosectomy. This is followed by short-term placement of double pigtail transgastric stents and nasocystic catheter for post-procedural irrigation and drainage. This review will summarise the current status of direct endoscopic necrosectomy.
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- 2012
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18. The Role of Endoscopy in the Management of Cystic Pancreatic Lesions
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Tiing Leong Ang MRCP (UK), FAMS (Gastroenterology)
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Medicine - Abstract
Pancreatic cystic lesions may be due to pseudocysts and related inflammatory fluid collections, simple cysts, cystic tumours such as serous cystadenoma, mucinous cystic neoplasm and intraductal papillary mucinous neoplasm, as well as solid tumours with areas of cystic degeneration. The main diagnostic challenge is to distinguish premalignant and malignant cystic lesions from benign cystic lesions. Cross-sectional imaging using computer tomography and magnetic resonance imaging/ magnetic resonance cholangiopancreatography provides the initial morphological characterization. Endoscopic ultrasound (EUS) is an important tool when diagnostic doubts persist and is crucial in the assessment of invasive malignancy. EUS-guided fine needle aspiration and cyst fluid analysis has been shown to be cost-effective for risk stratifying the malignant potential of cystic tumours and the need for surgical resection. In the management of symptomatic pseudocysts and related fluid collections, endoscopic drainage has been established as the preferred technique, with efficacy similar to surgery but lower costs and morbidity.
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- 2010
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19. A Prospective Comparison of EUS-Guided FNA Using 25-Gauge and 22-Gauge Needles
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Hiroo Imazu, Yujiro Uchiyama, Hiroshi Kakutani, kei-ichi Ikeda, Kazuki Sumiyama, Mitsuru Kaise, Salem Omar, Tiing Leong Ang, and Hisao Tajiri
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Diseases of the digestive system. Gastroenterology ,RC799-869 - Abstract
Background and Aims. There are limited data on the differences in diagnostic yield between 25-gauge and 22-gauge EUS-FNA needles. This prospective study compared the difference in diagnostic yield between a 22-gauge and a 25-gauge needle when performing EUS-FNA. Methods. Forty-three patients with intraluminal or extraluminal mass lesions and/or lymphadenopathy were enrolled prospectively. EUS-FNA was performed for each mass lesion using both 25- and 22-gauge needles. The differences in accuracy rate, scoring of needle visibility, ease of puncture and quantity of obtained specimen were evaluated. Results. The overall accuracy of 22- and 25-gauge needle was similar at 81% and 76% respectively (N.S). Likewise the visibility scores of both needles were also similar. Overall the quantity of specimen obtained higher with the 22-gauge needle (score: 1.64 vs. P
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- 2009
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20. Healthcare in the era of climate change and the need for environmental sustainability.
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Chin Hock Tee, Nicholas, Yeo, Jo-Anne, Choolani, Mahesh, Kian Keong Poh, and Tiing Leong Ang
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Climate change is an existential threat to humanity. While the healthcare sector must manage the health-related consequences of climate change, it is a significant contributor to greenhouse gas emissions, responsible for up to 4.6% of global emission, aggravating global warming. Within the hospital environment, the three largest contributors to greenhouse gas emissions are the operating theatre, intensive care unit and gastrointestinal endoscopy. Knowledge of the health-related burden of climate change and the potential transformative health benefits of climate action is important to all health professionals, as they play crucial roles in effecting change. This article summarises the available literature on the impact of healthcare on climate change and efforts in mitigation, focusing on the intrinsic differences and similarities across the operating theatre complex, intensive care unit and gastrointestinal endoscopy unit. It also discusses strategies to reduce carbon footprint. [ABSTRACT FROM AUTHOR]
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- 2024
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21. Development and validation of a deep learning system for detection of small bowel pathologies in capsule endoscopy: a pilot study in a Singapore institution.
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Bochao Jiang, Dorosan, Michael, Justin Wen Hao Leong, Hock Ong, Marcus Eng, Sean Shao Wei Lam, and Tiing Leong Ang
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Introduction: Deep learning models can assess the quality of images and discriminate among abnormalities in small bowel capsule endoscopy (CE), reducing fatigue and the time needed for diagnosis. They serve as a decision support system, partially automating the diagnosis process by providing probability predictions for abnormalities. Methods: We demonstrated the use of deep learning models in CE image analysis, specifically by piloting a bowel preparation model (BPM) and an abnormality detection model (ADM) to determine frame‑level view quality and the presence of abnormal findings, respectively. We used convolutional neural network‑based models pretrained on large‑scale open‑domain data to extract spatial features of CE images that were then used in a dense feed‑forward neural network classifier. We then combined the open‑source Kvasir‑Capsule dataset (n = 43) and locally collected CE data (n = 29). Results: Model performance was compared using averaged five‑fold and two‑fold cross‑validation for BPMs and ADMs, respectively. The best BPM model based on a pre-trained ResNet50 architecture had an area under the receiver operating characteristic and precision-recall curves of 0.969±0.008 and 0.843±0.041, respectively. The best ADM model, also based on ResNet50, had top-1 and top-2 accuracies of 84.03±0.051 and 94.78±0.028, respectively. The models could process approximately 200–250 images per second and showed good discrimination on time‑critical abnormalities such as bleeding. Conclusion: Our pilot models showed the potential to improve time to diagnosis in CE workflows. To our knowledge, our approach is unique to the Singapore context. The value of our work can be further evaluated in a pragmatic manner that is sensitive to existing clinician workflow and resource constraints. [ABSTRACT FROM AUTHOR]
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- 2024
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22. Ulcerative colitis: STRIDE-ing beyond symptoms with new standards.
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Shu Wen Tay, Kevin Kim Jun Teh, Tiing-Leong Ang, and Malcolm Tan
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The landscape of ulcerative colitis has changed in the last two decades. Advancements in pharmacotherapeutics have heralded the introduction of new treatment options, with many agents in development. Better clinical outcomes are seen with tighter disease control, made possible with greater understanding of inflammatory pathways and their blockade with drugs. There has been a resultant shift in treatment targets, beyond symptoms to endoscopic and histological healing. Controlling the burden of disease activity also lowers the risk of developing colorectal cancer. Colorectal cancer screening now requires the use of dye‑based agents and high‑definition colonoscopy to improve the detection of colonic neoplasms. [ABSTRACT FROM AUTHOR]
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- 2024
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23. Is this the end of colonoscopy screening for colorectal cancer? An Asia‐Pacific perspective
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Rashid N. Lui, Sunny H. Wong, Nik Sheng Ding, Masau Sekiguchi, Jun Yu, Tiing‐Leong Ang, Khay‐Guan Yeoh, Han‐Mo Chiu, and Joseph J. Y. Sung
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Hepatology ,Gastroenterology - Published
- 2023
24. Non-alcoholic fatty liver disease screening in type 2 diabetes mellitus: A cost-effectiveness and price threshold analysis
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Bryan Peide Choo, George Boon-Bee Goh, Sing Yi Chia, Hong Choon Oh, Ngiap Chuan Tan, Jessica Yi Lyn Tan, Tiing Leong Ang, Yong Mong Bee, and Yu Jun Wong
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Diabetes Mellitus, Type 2 ,Non-alcoholic Fatty Liver Disease ,Cost-Benefit Analysis ,Research ,Humans ,General Medicine ,Fibrosis - Abstract
Introduction: The cost-effectiveness of screening asymptomatic non-alcoholic fatty liver disease (NAFLD) patients remains debatable, with current studies assuming lifelong benefits of NAFLD screening while neglecting cardiovascular outcomes. This study aims to assess the cost-effectiveness of NAFLD screening among type 2 diabetes mellitus (T2DM) patients, and to establish a price threshold for NAFLD treatment, when it becomes available. Method: A Markov model was constructed comparing 4 screening strategies (versus no screening) to identify NAFLD with advanced fibrosis among T2DM patients: fibrosis-4 (FIB-4), vibration-controlled transient elastography (VCTE), FIB-4 and VCTE (simultaneous), and FIB-4 and VCTE (sequential). Sensitivity analyses and price threshold analyses were performed to assess parameter uncertainties in the results. Results: VCTE was the most cost-effective NAFLD screening strategy (USD24,727/quality-adjusted life year [QALY]), followed by FIB-4 (USD36,800/QALY), when compared to no screening. Probabilistic sensitivity analysis revealed a higher degree of certainty for VCTE as a cost-effective strategy compared to FIB-4 (90.7% versus 73.2%). The duration of expected screening benefit is the most influential variable based on incremental cost-effectiveness ratio tornado analysis. The minimum duration of screening benefit for NAFLD screening to be cost-effective was at least 2.6 years. The annual cost of NAFLD treatment should be less than USD751 for NAFLD screening to be cost-effective. Conclusion: Both VCTE and FIB-4 are cost-effective NAFLD screening strategies among T2DM patients in Singapore. However, given the lack of access to VCTE at primacy care and potential budget constraints, FIB-4 can also be considered for NAFLD screening among T2DM patients in Singapore. Keywords: Cost-effectiveness analysis, fatty liver, screening, liver fibrosis, population health
- Published
- 2022
25. Third Asia-Pacific consensus recommendations on colorectal cancer screening and postpolypectomy surveillance
- Author
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Joseph J Y Sung, Han-Mo Chiu, David Lieberman, Ernst J Kuipers, Matthew D Rutter, Finlay Macrae, Khay-Guan Yeoh, Tiing Leong Ang, Vui Heng Chong, Sneha John, Jingnan Li, Kaichun Wu, Simon S M Ng, Govind K Makharia, Murdani Abdullah, Nozomu Kobayashi, Masau Sekiguchi, Jeong-Sik Byeon, Hyun-Soo Kim, Susan Parry, Patricia Anne I Cabral-Prodigalidad, Deng-Chyang Wu, Suparkij Khomvilai, Rashid N Lui, Sunny Wong, Yu-Min Lin, E Dekker, Gastroenterology & Hepatology, Gastroenterology and Hepatology, CCA - Cancer Treatment and Quality of Life, CCA - Imaging and biomarkers, and AGEM - Amsterdam Gastroenterology Endocrinology Metabolism
- Subjects
Adenoma ,Asia ,Consensus ,SDG 3 - Good Health and Well-being ,COLORECTAL CANCER SCREENING ,Gastroenterology ,Colonic Polyps ,Humans ,Colonoscopy ,Colorectal Neoplasms ,Early Detection of Cancer - Abstract
The Asia-Pacific region has the largest number of cases of colorectal cancer (CRC) and one of the highest levels of mortality due to this condition in the world. Since the publishing of two consensus recommendations in 2008 and 2015, significant advancements have been made in our knowledge of epidemiology, pathology and the natural history of the adenoma-carcinoma progression. Based on the most updated epidemiological and clinical studies in this region, considering literature from international studies, and adopting the modified Delphi process, the Asia-Pacific Working Group on Colorectal Cancer Screening has updated and revised their recommendations on (1) screening methods and preferred strategies; (2) age for starting and terminating screening for CRC; (3) screening for individuals with a family history of CRC or advanced adenoma; (4) surveillance for those with adenomas; (5) screening and surveillance for sessile serrated lesions and (6) quality assurance of screening programmes. Thirteen countries/regions in the Asia-Pacific region were represented in this exercise. International advisors from North America and Europe were invited to participate.
- Published
- 2022
26. Use of artificial intelligence in the management of T1 colorectal cancer: a new tool in the arsenal or is deep learning out of its depth?
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Weiquan Li, James, Lai Mun Wang, Katsuro Ichimasa, Weicong Lin, Kenneth, Chi-Yong Ngu, James, and Tiing Leong Ang
- Subjects
ARTIFICIAL intelligence ,COLORECTAL cancer ,DEEP learning ,LYMPHATIC metastasis ,UNNECESSARY surgery - Abstract
The field of artificial intelligence is rapidly evolving, and there has been an interest in its use to predict the risk of lymph node metastasis in T1 colorectal cancer. Accurately predicting lymph node invasion may result in fewer patients undergoing unnecessary surgeries; conversely, inadequate assessments will result in suboptimal oncological outcomes. This narrative review aims to summarize the current literature on deep learning for predicting the probability of lymph node metastasis in T1 colorectal cancer, highlighting areas of potential application and barriers that may limit its generalizability and clinical utility. [ABSTRACT FROM AUTHOR]
- Published
- 2024
- Full Text
- View/download PDF
27. Academy of Medicine, Singapore clinical guideline on endoscopic surveillance and management of gastric premalignant lesions
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Vikneswaran Namasivayam, Calvin J Koh, Stephen Tsao, Jonathan Lee, Khoon Lin Ling, Christopher Khor, Tony Lim, James Weiquan Li, Benjamin CH Yip, Ikram Hussain, Tju Siang Chua, Bin Chet Toh, Hock Soo Ong, Lai Mun Wang, Jimmy BY So, Ming Teh, Khay Guan Yeoh, and Tiing Leong Ang
- Subjects
General Medicine - Abstract
Gastric cancer (GC) has a good prognosis, if detected at an early stage. The intestinal subtype of GC follows a stepwise progression to carcinoma, which is treatable with early detection and intervention using high-quality endoscopy. Premalignant lesions and gastric epithelial polyps are commonly encountered in clinical practice. Surveillance of patients with premalignant gastric lesions may aid in early diagnosis of GC, and thus improve chances of survival. An expert professional workgroup was formed to summarise the current evidence and provide recommendations on the management of patients with gastric premalignant lesions in Singapore. Twenty-five recommendations were made to address screening and surveillance, strategies for detection and management of gastric premalignant lesions, management of gastric epithelial polyps, and pathological reporting of gastric premalignant lesions. Keywords: Early gastric neoplasia, endoscopic surveillance, gastric cancer, intestinal metaplasia, polyp
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- 2022
28. Spatiotemporal Genomic Profiling of Intestinal Metaplasia Reveals Clonal Dynamics of Gastric Cancer Progression
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Kie Kyon Huang, Haoran Ma, Tomoyuki Uchihara, Taotao Sheng, Roxanne Hui Heng Chong, Feng Zhu, Supriya Srivastava, Su Ting Tay, Raghav Sundar, Angie Lay Keng Tan, Xuewen Ong, Minghui Lee, Shamaine Wei Ting Ho, Tom Lesluyes, Peter Van Loo, Joy Shijia Chua, Kalpana Ramnarayanan, Tiing Leong Ang, Christopher Khor, Jonathan Wei Jie Lee, Stephen Kin Kwok Tsao, Ming Teh, Hyunsoo Chung, Jimmy Bok Yan So, Khay Guan Yeoh, Patrick Tan, and Singapore Gastric Cancer Consortium
- Abstract
Intestinal metaplasia (IM) is a pre-malignant condition of the gastric mucosa associated with increased gastric cancer (GC) risk. We analyzed 1256 gastric samples (1152 IMs) from 692 subjects through a prospective 10-year study. We identified 26 IM driver genes in diverse pathways including chromatin regulation (ARID1A) and intestinal homeostasis (SOX9), largely occurring as small clonal events. Analysis of clonal dynamics between and within subjects, and also longitudinally across time, revealed that IM clones are likely transient but increase in size upon progression to dysplasia, with eventual transmission of somatic events to paired GCs. Single-cell and spatial profiling highlighted changes in tissue ecology and lineage heterogeneity in IM, including an intestinal stem-cell dominant cellular compartment linked to early malignancy. Expanded transcriptome profiling revealed expression-based molecular subtypes of IM, including a body-resident “pseudoantralized” subtype associated with incomplete histology, antral/intestinal cell types,ARID1Amutations, inflammation, and microbial communities normally associated with the healthy oral tract. We demonstrate that combined clinical- genomic models outperform clinical-only models in predicting IMs likely to progress. Our results raise opportunities for GC precision prevention and interception by highlighting strategies for accurately identifying IM patients at high GC risk and a role for microbial dysbiosis in IM progression.
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- 2023
29. Role of artificial intelligence in early detection and screening for pancreatic adenocarcinoma
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Kenneth Weicong Lin, Tiing Leong Ang, and James Weiquan Li
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General Medicine - Published
- 2022
30. Evaluation of a six-probe cocktail (caffeine, tolbutamide, omeprazole, dextromethorphan, midazolam, and digoxin) approach to estimate hepatic drug detoxification capability and dosage requirements after a single oral dosing in healthy Chinese volunteers
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Seok Hwee Koo, Gaik Hong Soon, Alain Pruvost, Henri Benech, Tiing Leong Ang, Edmund Jon Deoon Lee, and Daphne Shih Wen Ang
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Pharmacology ,China ,Digoxin ,Midazolam ,Tolbutamide ,General Medicine ,Dextromethorphan ,Healthy Volunteers ,Cytochrome P-450 CYP2C19 ,Cytochrome P-450 Enzyme System ,Caffeine ,Humans ,Drug Interactions ,Omeprazole - Abstract
The primary objectives of this study were to investigate the suitability of a 6-probe cocktail (caffeine, tolbutamide, omeprazole, dextromethorphan, midazolam, and digoxin) to be used as a tool for assessing the activity of drug metabolizing enzymes and transporters, and examine differences in the way drugs are handled among groups with different genetic regulation of these processes. This was a single-center, open-label, phase I clinical study involving 20 young, healthy Chinese volunteers (equal gender distribution). The subjects were administered a single, oral dose of the 6-probe cocktail and serum samples were collected to assess the disposition of the different probe substrates and produced metabolites. The serum samples were analyzed using ultra-performance liquid chromatography-electrospray ionization-tandem mass spectrometry technology. The DNA samples were subjected to whole exome sequencing. Nineteen healthy volunteers completed the study. The 6-probe cocktail was safe and well-tolerated by all the subjects. The parent substrates and metabolites-caffeine (paraxanthine), dextromethorphan (dextrorphan), digoxin, midazolam (1-hydroxy-midazolam), omeprazole (5-hydroxy-omeprazole), and tolbutamide (4-hydroxy-tolbutamide)-were within the detectable window. Genetic variations known to alter drug metabolism (CYP2D6*10, CYP2C19*2, CYP2C19*3, and CYP2C9*3) were identified and generally correlated with phenotypic status. The 6-probe cocktail appeared to be suitable for assessing drug metabolizing activities. This, in conjunction with individual genetics, will pave the way for the implementation of personalized medicine in clinical practice. This will hopefully improve efficacy and reduce the incidence of adverse drug reactions.
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- 2022
31. Clinical guidance on endoscopic management of colonic polyps in Singapore
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Vikneswaran Namasivayam, James Weiquan Li, Chern Hao Chong, Christopher Khor, Tiing Leong Ang, Jit Fong Lim, Khay Guan Yeoh, Tju Siang Chua, Kok Ann Gwee, Kok Yang Tan, Lai Mun Wang, and Charles Vu
- Subjects
Adenoma ,Curative resection ,Singapore ,medicine.medical_specialty ,medicine.diagnostic_test ,Colorectal cancer ,business.industry ,General surgery ,Perforation (oil well) ,Colonic Polyps ,Colonoscopy ,Review Article ,General Medicine ,Endoscopic management ,medicine.disease ,United States ,Endoscopic polypectomy ,Colonic Neoplasms ,medicine ,Humans ,Endoscopic resection ,Surveillance colonoscopy ,Colorectal Neoplasms ,business - Abstract
Colonoscopy with endoscopic resection of detected colonic adenomas interrupts the adenoma-carcinoma sequence and reduces the incidence of colorectal cancer and cancer-related mortality. In the past decade, there have been significant developments in instruments and techniques for endoscopic polypectomy. Guidelines have been formulated by various professional bodies in Europe, Japan and the United States, but some of the recommendations differ between the various bodies. An expert professional workgroup under the auspices of the Academy of Medicine, Singapore, was set up to provide guidance on the endoscopic management of colonic polyps in Singapore. A total of 23 recommendations addressed the following issues: accurate description and diagnostic evaluation of detected polyps; techniques to reduce the risk of post-polypectomy bleeding and delayed perforation; the role of specific endoscopic resection techniques; the histopathological criteria for defining endoscopic cure; and the role of surveillance colonoscopy following curative resection.
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- 2022
32. Efficacy of international web‐based educational intervention in the detection of high‐risk flat and depressed colorectal lesions higher (CATCH project) with a video: Randomized trial
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Mineo, Iwatate, Daizen, Hirata, Carlos Paolo D, Francisco, Jonard Tan, Co, Jeong-Sik, Byeon, Neeraj, Joshi, Rupa, Banerjee, Duc Trong, Quach, Than Than, Aye, Han-Mo, Chiu, Louis H S, Lau, Siew C, Ng, Tiing Leong, Ang, Supakij, Khomvilai, Xiao-Bo, Li, Shiaw-Hooi, Ho, Wataru, Sano, Santa, Hattori, Mikio, Fujita, Yoshitaka, Murakami, Masaaki, Shimatani, Yuzo, Kodama, and Yasushi, Sano
- Subjects
Internet ,Asia ,Gastroenterology ,Humans ,Radiology, Nuclear Medicine and imaging ,Colonoscopy ,Colorectal Neoplasms - Abstract
Three subcategories of high-risk flat and depressed lesions (FDLs), laterally spreading tumors non-granular type (LST-NG), depressed lesions, and large sessile serrated lesions (SSLs), are highly attributable to post-colonoscopy colorectal cancer (CRC). Efficient and organized educational programs on detecting high-risk FDLs are lacking. We aimed to explore whether a web-based educational intervention with training on FIND clues (fold deformation, intensive stool/mucus attachment, no vessel visibility, and demarcated reddish area) may improve the ability to detect high-risk FDLs.This was an international web-based randomized control trial that enrolled non-expert endoscopists in 13 Asian countries. The participants were randomized into either education or non-education group. All participants took the pre-test and post-test to read 60 endoscopic images (40 high-risk FDLs, five polypoid, 15 no lesions) and answered whether there was a lesion. Only the education group received a self-education program (video and training questions and answers) between the tests. The primary outcome was a detection rate of high-risk FDLs.In total, 284 participants were randomized. After excluding non-responders, the final data analyses were based on 139 participants in the education group and 130 in the non-education group. The detection rate of high-risk FDLs in the education group significantly improved by 14.7% (66.6-81.3%) compared with -0.8% (70.8-70.0%) in the non-education group. Similarly, the detection rate of LST-NG, depressed lesions, and large SSLs significantly increased only in the education group by 12.7%, 12.0%, and 21.6%, respectively.Short self-education focusing on detecting high-risk FDLs was effective for Asian non-expert endoscopists. (UMIN000042348).
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- 2022
33. CHESS‐ALARM score to stratify decompensation risk in compensated advanced chronic liver disease patients: An international multicenter study
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Yu Jun Wong, Jia Li, Chuan Liu, Zhaojin Chen, Yiong Huak Chan, Martin Putera, Kok Ban Teh, Tiing Leong Ang, Lili Zhao, Zhongfang Yan, Rahul Kumar, Xin Li, and Xiaolong Qi
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End Stage Liver Disease ,Liver Cirrhosis ,Hepatology ,Liver Diseases ,Gastroenterology ,Elasticity Imaging Techniques ,Humans ,Esophageal and Gastric Varices ,Obesity, Morbid - Abstract
A combination of platelet and elastography (PE criteria) was proposed to identify compensated advanced chronic liver disease (cACLD) patients at risk of liver decompensation. We aim to validate and refine PE criteria by developing a new predictive score to predict decompensation in Asian cACLD patients.An international cohort of 633 cACLD patients with liver stiffness measurement (LSM) and esophagogastroduodenoscopy performed were included. We validated PE criteria to predict first liver decompensation using competing risk analysis, with death and hepatocellular carcinoma as competing events. We developed a predictive model using proportional subdistribution hazard regression. Prognostic accuracy was compared with the model of end-stage liver disease (MELD), albumin-bilirubin (ALBI), and ALBI-FIB-4 score using time-dependent area under operative characteristic curve (tAUC).Sixty patients developed decompensation over the median follow-up of 39 months. Favorable Baveno VI status ruled out cACLD patients at risk of liver decompensation. LSM 25 kPa was suboptimal to predict cACLD patients who will develop liver decompensation. We developed CHESS-ALARM score by incorporating age, platelet, and gender into LSM. CHESS-ALARM score (tAUC = 0.86, 95% confidence interval [CI]: 0.79-0.94) has significantly higher accuracy than MELD (tAUC: 0.61), ALBI (tAUC: 0.62), ALBI-FIB-4 (tAUC: 0.70), and LSM 25 kPa (tAUC: 0.54) to predict liver decompensation at 5 years (P 0.05 for all). Patients with CHESS-ALARM score ≥ -0.37 had an 11-fold higher risk of decompensation (subdistribution hazard ratio = 11.2, 95% CI: 5.1-24.5).CHESS-ALARM score can be readily incorporated into clinical practice of cACLD patients to estimate individual risk of liver decompensation; however, more data are required in morbidly obese cACLD patients of nonviral etiology.
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- 2022
34. Comparison of a Hemostatic Powder and Standard Treatment in the Control of Active Bleeding From Upper Nonvariceal Lesions
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James Y.W. Lau, Rapat Pittayanon, Andrew Kwek, Raymond S. Tang, Heyson Chan, Rungsun Rerknimitr, June Lee, Tiing Leong Ang, Bing-Yee Suen, Yuan-yuan Yu, Francis K.L. Chan, and Joseph J.Y. Sung
- Subjects
Adult ,Recurrence ,Hemostasis, Endoscopic ,Internal Medicine ,Hong Kong ,Humans ,General Medicine ,Powders ,Gastrointestinal Hemorrhage ,Hemostatics - Abstract
The effectiveness of the hemostatic powder TC-325 as a single endoscopic treatment for acute nonvariceal upper gastrointestinal bleeding is uncertain.To compare TC-325 with standard endoscopic hemostatic treatments in the control of active bleeding from nonvariceal upper gastrointestinal causes.One-sided, noninferiority, randomized, controlled trial. (ClinicalTrials.gov: NCT02534571).University teaching hospitals in the Asia-Pacific region.224 adult patients with acute bleeding from a nonvariceal cause on upper gastrointestinal endoscopy.TC-325 (The primary outcome was control of bleeding within 30 days. Other outcomes included failure to control bleeding during index endoscopy, recurrent bleeding after initial hemostasis, further interventions, blood transfusion, hospitalization, and death.224 patients were enrolled (136 with gastroduodenal ulcers [60.7%], 33 with tumors [14.7%], and 55 with other causes of bleeding [24.6%]). Bleeding was controlled within 30 days in 100 of 111 patients (90.1%) in the TC-325 group and 92 of 113 (81.4%) in the standard treatment group (risk difference, 8.7 percentage points [1-sided 95% CI, 0.95 percentage point]). There were fewer failures of hemostasis during index endoscopy with TC-325 (3 [2.7%] vs. 11 [9.7%]; odds ratio, 0.26 [CI, 0.07 to 0.95]). Recurrent bleeding within 30 days did not differ between groups (9 [8.1%] vs. 10 [8.8%]). The need for further interventions also did not differ between groups (further endoscopic treatment: 8 [7.2%] vs. 10 [8.8%]; angiography: 2 [1.8%] vs. 4 [3.5%]; surgery: 1 [0.9%] vs. 0). There were 14 deaths in each group (12.6% vs. 12.4%).Clinicians were not blinded to treatment.TC-325 is not inferior to standard treatment in the endoscopic control of bleeding from nonvariceal upper gastrointestinal causes.General Research Fund to the University Grants Committee, Hong Kong SAR Government.
- Published
- 2022
35. Editorial: Optimizing the success of cold snare polypectomy in colonoscopy practice
- Author
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Tiing Leong Ang and Han‐Mo Chiu
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Hepatology ,Gastroenterology - Published
- 2023
36. Colonic stenting in acute malignant large bowel obstruction: audit of efficacy and safety in a Singapore tertiary referral centre.
- Author
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Weiquan Li, James, Chi-Yong Ngu, James, Lim, Kok Ren, Shu Wen Tay, Bochao Jiang, Wijaya, Ramesh, Yusof, Sulaiman, Jianming Ong, Calvin, Kwek, Andrew Boon Eu, and Tiing Leong Ang
- Abstract
Introduction: Acute malignant large bowel obstruction (MBO) occurs in 8%-15% of colorectal cancer patients. Self-expandable metal stents (SEMS) have progressed from a palliative modality to use as bridge to surgery (BTS). We aimed to assess the safety and efficacy of SEMS for MBO in our institution. Methods: The data of patients undergoing SEMS insertion for MBO were reviewed. Technical success was defined as successful SEMS deployment across tumour without complications. Clinical success was defined as colonic decompression without requiring further surgical intervention. Rates of complications, median time to surgery, types of surgery and rates of recurrence were studied. Results: Seventy-nine patients underwent emergent SEMS placement from September 2013 to February 2020. Their mean age was 68.8 ± 13.8 years and 43 (54%) patients were male. Mean tumour length was 4.2 cm ± 2.2 cm; 89.9% of malignant strictures were located distal to the splenic flexure. Technical and clinical success was 94.9% and 98.7%, respectively. Perforation occurred in 5.1% of patients, with none having stent migration or bleeding. Fifty (63.3%) patients underwent SEMS insertion as BTS. Median time to surgery was 20 (range 6-57) days. Most (82%) patients underwent minimally invasive surgery. Primary anastomosis rate was 98%. Thirty-nine patients had follow-up beyond 1-year posttreatment (median 34 months). Local recurrence and distant metastasis were observed in 4 (10.3%) and 5 (12.8%) patients, respectively. Conclusion: Insertion of SEMS for acute MBO has high success rates and a good safety profile. Most patients in this audit underwent minimally invasive surgery and primary anastomosis after successful BTS. [ABSTRACT FROM AUTHOR]
- Published
- 2023
- Full Text
- View/download PDF
37. Cronkhite-Canada Syndrome Masquerading as Inflammatory Bowel Disease.
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Wen Hao Leong, Justin, Lai Mun Wang, Weiquan Li, James, Tiing Leong Ang, Kwek, Boon Eu Andrew, and Peng Lan Ong, Jeannie
- Published
- 2023
- Full Text
- View/download PDF
38. Real-World Validation of a Computer-Aided Diagnosis System for Prediction of Polyp Histology in Colonoscopy: A Prospective Multicenter Study.
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Weiquan Li, James, Chun Ho Wu, Clement, Wei Jie Lee, Jonathan, Liang, Raymond, Shook Ting Soon, Gwyneth, Lai Mun Wang, Xuan Han Koh, Jianyi Koh, Calvin, Wei Da Chew, Weicong Lin, Kenneth, Mann Yie Thian, Matthew, Ronnie, Guowei Kim, Jen Lock Khor, Christopher, Kwong Ming Fock, Tiing Leong Ang, and Bok Yan So, Jimmy
- Published
- 2023
- Full Text
- View/download PDF
39. Academy of Medicine, Singapore clinical guideline on the use of sedation by non-anaesthesiologists during gastrointestinal endoscopy in the hospital setting
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Tiing Leong Ang, Edwin Seet, Yaw Chong Goh, Wee Khoon Ng, Calvin Jianyi Koh, Hock Foong Lui, James Weiquan Li, Aung Myint Oo, Kieron Boon Leng Lim, Kok Sun Ho, Min Hoe Chew, Wai Leong Quan, Damien Meng Yew Tan, Kheng Hong Ng, Hak Su Goh, Wai Kit Cheong, Philip Tseng, and Khoon Lin Ling
- Subjects
Singapore ,Conscious Sedation ,Humans ,Hypnotics and Sedatives ,General Medicine ,Endoscopy, Gastrointestinal ,Hospitals - Abstract
Introduction: In Singapore, non-anaesthesiologists generally administer sedation during gastrointestinal endoscopy. The drugs used for sedation in hospital endoscopy centres now include propofol in addition to benzodiazepines and opiates. The requirements for peri-procedural monitoring and discharge protocols have also evolved. There is a need to develop an evidence-based clinical guideline on the safe and effective use of sedation by non-anaesthesiologists during gastrointestinal endoscopy in the hospital setting. Methods: The Academy of Medicine, Singapore appointed an expert workgroup comprising 18 gastroenterologists, general surgeons and anaesthesiologists to develop guidelines on the use of sedation during gastrointestinal endoscopy. The workgroup formulated clinical questions related to different aspects of endoscopic sedation, conducted a relevant literature search, adopted Grading of Recommendations, Assessment, Development and Evaluation (GRADE) methodology and developed recommendations by consensus using a modified Delphi process. Results: The workgroup made 16 recommendations encompassing 7 areas: (1) purpose of sedation, benefits and disadvantages of sedation during gastrointestinal endoscopy; (2) pre-procedural assessment, preparation and consent taking for sedation; (3) Efficacy and safety of drugs used in sedation; (4) the role of anaesthesiologist-administered sedation during gastrointestinal endoscopy; (5) performance of sedation; (6) post-sedation care and discharge after sedation; and (7) training in sedation for gastrointestinal endoscopy for non-anaesthesiologists. Conclusion: These recommendations serve to guide clinical practice during sedation for gastrointestinal endoscopy by non-anaesthesiologists in the hospital setting. Keywords: Benzodiazepines, gastrointestinal endoscopy opiates, propofol, sedation
- Published
- 2022
40. A Questionnaire-Based Survey on the Impact of the COVID-19 Pandemic on Gastrointestinal Endoscopy in Asia
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Akihito Nagahara, Ki Baik Hahm, Koji Otani, Akiko Shiotani, Tiing Leong Ang, Kazunari Murakami, Mitsushige Sugimoto, Toshio Watanabe, Maria Carla Tablante, Qi Zhu, Varayu Prachayakul, Shin Fukudo, Satoru Yamaguchi, Takeshi Kamiya, Murdani Abdullah, Satoshi Motoya, Akira Higashimori, Francis K.L. Chan, and Hidekazu Suzuki
- Subjects
Face shield ,medicine.medical_specialty ,business.product_category ,Asia ,Nausea ,Consensus Report ,Endoscopy, Gastrointestinal ,Personal protective equipment ,Surveys and Questionnaires ,Pandemic ,medicine ,Severe acute respiratory syndrome coronavirus 2 ,Humans ,Medical prescription ,Pandemics ,Irritable bowel syndrome ,medicine.diagnostic_test ,business.industry ,SARS-CoV-2 ,General surgery ,Gastroenterology ,COVID-19 ,Endoscopy ,medicine.disease ,Clinical research ,Vomiting ,medicine.symptom ,business - Abstract
Introduction: The COVID-19 outbreak abruptly restricted gastrointestinal (GI) endoscopy services during the first wave of the pandemic. We aimed to assess the impact of COVID-19 on the practice of GI endoscopy in Asian countries. Methods: This was an International Questionnaire-based Internet Survey conducted at multiple facilities by the International Gastrointestinal Consensus Symposium. A total of 166 respondents in Japan, China, Hong Kong, South Korea, Philippines, Thailand, Indonesia, and Singapore participated in this study. Results: The volume of endoscopic screening or follow-up endoscopies and therapeutic endoscopies were markedly reduced during the first wave of the pandemic, which was mainly attributed to the decreased number of outpatients, cancellations by patients, and adherence to the guidelines of academic societies. The most common indications for GI endoscopy during the first wave were GI bleeding, cholangitis or obstructive jaundice, and a highly suspicious case of neoplasia. The most common GI symptoms of COVID-19 patients during the infected period included diarrhea, nausea, and vomiting. The pandemic exacerbated some GI diseases, such as functional dyspepsia and irritable bowel syndrome. There were cases with delayed diagnosis of cancers due to postponed endoscopic procedures, and the prescription of proton pump inhibitors/potassium-competitive acid blockers, steroids, immunosuppressive agents, and biologics was delayed or canceled. The personal protective equipment used during endoscopic procedures for high-risk patients were disposable gloves, disposable gowns, N95 or equivalent masks, and face shields. However, the devices on the patient side during endoscopic procedures included modified surgical masks, mouthpieces with filters, and disposable vinyl boxes or aerosol boxes covering the head. Furthermore, the time for education, basic research, clinical research, and daily clinical practice decreased during the first wave. Conclusion: This study demonstrated that the COVID-19 pandemic profoundly affected the method of performing GI endoscopy and medical treatment for patients with GI diseases in Asian countries.
- Published
- 2021
41. Editorial: A learning curve for duodenal endoscopic submucosal dissection: Nuances and caveats
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Yoji Takeuchi and Tiing Leong Ang
- Subjects
Hepatology ,Endoscopic Mucosal Resection ,Duodenum ,Gastroscopy ,Gastroenterology ,Humans ,Learning Curve - Published
- 2022
42. Post-papillectomy bleeding: Hemostatic powder to the rescue?
- Author
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Andrew Boon Eu Kwek and Tiing Leong Ang
- Subjects
Hepatology ,Gastroenterology ,Humans ,Hemorrhage ,Powders ,Hemostasis, Surgical ,Hemostatics - Published
- 2022
43. Harnessing the potential of artificial intelligence‐assisted colonoscopy to reduce the risk of post‐colonoscopy interval colorectal cancer
- Author
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Tiing Leong Ang and Joseph Jao‐Yiu Sung
- Subjects
Hepatology ,Gastroenterology - Published
- 2023
44. Artificial intelligence and polyp detection in colonoscopy: Use of a single neural network to achieve rapid polyp localization for clinical use
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Tiing Leong Ang, Kenny De Wei Chong, Kwong Ming Fock, Tiongsun Chia, Yu Jun Wong, and James Weiquan Li
- Subjects
business.product_category ,Hepatology ,medicine.diagnostic_test ,Artificial neural network ,business.industry ,Intersection (set theory) ,Gastroenterology ,Colonic Polyps ,Colonoscopy ,Frame rate ,Object detection ,Artificial Intelligence ,Laptop ,medicine ,Humans ,Neural Networks, Computer ,Artificial intelligence ,business ,F1 score ,Expansive ,Algorithms - Abstract
Background and aims Artificial intelligence has been extensively studied to assist clinicians in polyp detection, but such systems usually require expansive processing power, making them prohibitively expensive and hindering wide adaption. The current study used a fast object detection algorithm, known as the YOLOv3 algorithm, to achieve real-time polyp detection on a laptop. In addition, we evaluated and classified the causes of false detections to further improve accuracy. Methods The YOLOv3 algorithm was trained and validated with 6,038 and 2,571 polyp images, respectively. Videos from live colonoscopies in a tertiary centre and those obtained from public databases were used for the training and validation sets. The algorithm was tested on 10 unseen videos from the CVC-Video ClinicDB dataset. Only bounding boxes with an intersection over union area of > 0.3 were considered positive predictions. Results Polyp detection rate in our study was 100%, with the algorithm able to detect every polyp in each video. Sensitivity, specificity and F1 score were 74.1%, 85.1% and 83.3, respectively. The algorithm achieved a speed of 61.2 frames per second (fps) on a desktop RTX2070 GPU and 27.2 fps on a laptop GTX2060 GPU. Nearly a quarter of false negatives happened when the polyps were at the corner of an image. Image blurriness accounted for approximately 3% and 9% of false positive and false negative detections, respectively. Conclusion The YOLOv3 algorithm can achieve real-time poly detection with high accuracy and speed on a desktop GPU, making it low-cost and accessible to most endoscopy centres worldwide.
- Published
- 2021
45. No health without mental health: united we stand.
- Author
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Kang Sim and Tiing Leong Ang
- Subjects
MENTAL health services ,CONTINUOUS performance test ,PEOPLE with mental illness ,MEDICAL personnel ,QUALITY of life - Abstract
The Singapore Medical Journal has published a special issue on mental health in honor of World Mental Health Day. The collection of articles covers various mental disorders, including ADHD, anorexia nervosa, depression, and psychosis. The articles explore topics such as diagnosis, treatment modalities, cognitive functioning, and the lived experience of individuals with mental disorders. The issue emphasizes the importance of addressing mental health and highlights the need for ongoing efforts to combat stigma and improve mental health care. [Extracted from the article]
- Published
- 2024
- Full Text
- View/download PDF
46. IDDF2022-ABS-0213 Gastric intestinal metaplasia may attenuate reflux symptoms – analysis of a large observational prospective cohort
- Author
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Si-Ying Tang, Jonathan Lee, Calvin J Koh, Feng Zhu, Jimmy So, Khek-Yu Ho, Supriya Srivastava, Stephen Tsao, Christopher Khor, Kwong-Ming Fock, Wee-Chian Lim, Khoon-Lin Ling, Tiing-Leong Ang, and Ming Teh
- Published
- 2022
47. Colorectal endoscopic full‐thickness resection: Initial experience from a tertiary centre in Singapore
- Author
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James Weiquan Li, Lai Mun Wang, Andrew Boon Eu Kwek, Chin Kimg Tan, and Tiing Leong Ang
- Subjects
medicine.medical_specialty ,medicine.diagnostic_test ,Colorectal cancer ,business.industry ,General surgery ,Neuroendocrine Cancer ,medicine ,Colonoscopy ,Full thickness resection ,medicine.disease ,business - Published
- 2021
48. The impact of unrestricted access to direct-acting antiviral among incarcerated hepatitis C virus-infected patients
- Author
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Sin-Yoong Chong, Prem Harichander Thurairajah, Tiing Leong Ang, Yu Jun Wong, Eng Kiong Teo, Fria Gloriba Manejero, Ngai Moh Law, Jessica Tan, Kwong Ming Fock, and Rajesh Kumar
- Subjects
Adult ,Male ,medicine.medical_specialty ,Carcinoma, Hepatocellular ,Cirrhosis ,Hepatitis C virus ,Population ,Subgroup analysis ,Hepacivirus ,RC799-869 ,medicine.disease_cause ,prisons ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,antiviral agents ,Humans ,Medicine ,030212 general & internal medicine ,hepatitis c, chronic ,education ,Molecular Biology ,Retrospective Studies ,education.field_of_study ,High prevalence ,Hepatology ,business.industry ,Prisoners ,Liver Neoplasms ,virus diseases ,Retrospective cohort study ,Hepatitis C ,Middle Aged ,Diseases of the digestive system. Gastroenterology ,medicine.disease ,digestive system diseases ,Treatment Outcome ,Female ,Original Article ,030211 gastroenterology & hepatology ,business ,Direct acting - Abstract
Background/Aims: Despite the disproportionally high prevalence rates of hepatitis C virus (HCV) amongst the incarcerated population, eradication remains challenging due to logistic and financial barriers. Although treatment prioritization based on disease severity is commonly practiced, the efficacy of such approach remained uncertain. We aimed to compare the impact of unrestricted access to direct-acting antiviral (DAA) among incarcerated HCV-infected patients in Singapore. Methods: In this retrospective study, we reviewed all incarcerated HCV-infected patients treated in our hospital during the restricted DAA era (2013-2018) and unrestricted DAA access era (2019). Study outcomes included the rate of sustained virological response (SVR), treatment completion and treatment default. Subgroup analysis was performed based on the presence of liver cirrhosis, HCV genotype and HCV treatment types. Results: A total of 1,001 HCV patients was followed-up for 1,489 person-year. They were predominantly male (93%) with genotype-3 HCV infection (71%), and 38% were cirrhotic. The overall SVR during the restricted DAA access era and unrestricted DAA access era were 92.1% and 99.1%, respectively. Unrestricted access to DAA exponentially improved the treatment access among HCV-infected patients by 460%, resulting in a higher SVR rate (99% vs. 92%, P=0.003), higher treatment completion rate (99% vs. 93%, P
- Published
- 2021
49. Tis Not a Leiomyoma! Two Cases of Postendoscopic Full-Thickness Resection Leiomyomatous Pseudopolyps
- Author
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Chin Kimg Tan, Lai Mun Wang, Lynne Goh, James Weiquan Li, Jinlin Lin, and Tiing Leong Ang
- Subjects
Hepatology ,Gastroenterology - Published
- 2021
50. Is it time to lower the colorectal cancer screening age in average-risk adults in Singapore?
- Author
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Khay Guan Yeoh and Tiing Leong Ang
- Subjects
Adult ,Singapore ,Average risk ,medicine.medical_specialty ,business.industry ,MEDLINE ,General Medicine ,Colorectal cancer screening ,Internal medicine ,Humans ,Mass Screening ,Medicine ,Colorectal Neoplasms ,business ,Early Detection of Cancer - Published
- 2021
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