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BACKGROUND: Chronic non-bloody diarrhea may be attributed either to functional or organic diseases. The latter category may present with malabsorption syndrome if there is extensive involvement of the small bowel, whereas diseases of the large bowel may only present with diarrhea sans malabsorption. Indian data has predominantly focussed on the etiological spectrum of malabsorption syndrome in adults. The primary aim of the current study was to evaluate etiological spectrum of chronic organic non-bloody diarrhea in India. METHODS: This prospective observational study was done at a tertiary care hospital in North India. Patients ≥ 18 years presenting with chronic non-bloody diarrhea of > 4 weeks duration were enrolled in the study after exclusion of patients with IBS and anal incontinence. RESULTS: During the study period of 12 months, 100 patients with chronic organic non-bloody diarrhea were evaluated. A definite etiological diagnosis was made in 97 patients (97%). The mean age of the patients was 48 ± 16.7 years (58% males). The median duration of diarrhea was 5.5 months (interquartile range [IQR] 3.5, 11). Inflammatory bowel disease (IBD) accounted for 45% of the cases making it the predominant cause for organic diarrhea. GI infections and adult-onset celiac disease accounted for 18% and 9% of the cases, respectively. Pancreatic disease, benign or neoplastic, accounted for 6% of the total cases. Notably, gastrointestinal (GI) malignancies manifesting as chronic non-bloody diarrhea were diagnosed in 5% of the patients. CONCLUSION: Our data suggests a paradigm shift in the etiological spectrum of chronic organic non-bloody diarrhea in India with the emergence of IBD as the predominant cause displacing GI infections.
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Endoscopic ultrasound-guided liver biopsy is increasingly being performed at several centers. It is also being promoted at endoscopy conferences. The currently available literature does not support the routine use of endoscopic ultrasound-guided liver biopsy as results are either inferior or comparable to percutaneous liver biopsy. We discuss the technical limitations of endoscopic ultrasound-guided liver biopsy when compared to percutaneous liver biopsy and the comparative studies in the current review. The routine use of endoscopic ultrasound-guided liver biopsy should be discouraged as it may get less tissue, the complication rate is similar and it is more costly.
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BACKGROUND: Dyspepsia includes a spectrum of symptoms ranging from epigastric pain and early satiety to postprandial fullness. The worldwide prevalence of dyspepsia is 20-30%. It is slightly higher in the Western population and occurs more frequently among women. While the precise prevalence of dyspepsia in India is not available, different studies estimate that it affects 7.6-49% of the Indian population. Through our current study, we wanted to understand the demographics, clinical profile, patient presentation, and management in India. We also wanted to document the pattern of use of proton pump inhibitors (PPI) and patient satisfaction with PPIs in Indian patients with dyspepsia. MATERIALS AND METHODS: This pan-India, multi-centric, cross-sectional, questionnaire-based, noninterventional, observational study was conducted between February and October 2021 in patients >18 years of age with a clinical diagnosis of any form of dyspepsia. Descriptive statistics were used for categorical variables, and between-group comparisons were made using Fischer's exact test, with p < 0.05 denoting statistical significance. RESULTS: A total of 3,739 patients from across 29 states of India participated in the study. Most of the patients were male (70.8%) and were from urban areas (56.8%). The highest percentage of patients were aged 31-40 (33.8%), and most patients (60.2%) had dyspepsia for a duration of 6-12 months. Patients with functional dyspepsia (FD) (78.5%) were significantly higher compared to organic dyspepsia (OD) (21.5%) (p < 0.001). The most frequent presenting symptoms were epigastric pain, nausea, vomiting, and heartburn. A quarter (25.6%) of the dyspepsia patients were associated with various comorbid conditions, of which diabetes mellitus, hypertension, and irritable bowel syndrome are the most common ones. A total of 619 patients in the study were on concomitant medications, of which the most common were antidiabetic drugs (271/619, 43.8%). Rabeprazole was the most frequently used PPI (2467/3739, 66.0%) among the study participants. The patient satisfaction analysis showed that, overall, patients were satisfied with PPIs, as most patients (~80%) agreed to almost all questions. The analysis for individual PPIs showed the highest "agree" responses in the rabeprazole group for almost all questions (12 of 13). Around 86.4% of patients on rabeprazole agreed with "immediate relief from acidity," 84.9% for "gives me complete relief," and 85.9% for "relief from nighttime acidity symptoms." CONCLUSION: Our study involving over 3,700 Indian patients with Dyspepsia adds to the growing knowledge of dyspepsia in India. Dyspepsia is more prevalent in males and in the 31-50 age group. FD is the most common form. Overall, patients were satisfied with PPIs in dyspepsia management in India. Patients on rabeprazole showed higher levels of medication adherence, satisfaction with symptom relief, convenience of therapy, and safety compared to patients on other PPIs. Against the backdrop of a paucity of reliable data about dyspepsia in India, our study results provide valuable insights into Dyspepsia and its management in an Indian setting.
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Dispepsia , Humanos , Masculino , Femenino , Adolescente , Adulto , Persona de Mediana Edad , Dispepsia/epidemiología , Dispepsia/diagnóstico , Rabeprazol/uso terapéutico , Estudios Transversales , Inhibidores de la Bomba de Protones/uso terapéutico , India/epidemiología , Dolor , DemografíaRESUMEN
Background and aims: Most studies to date have focused on liver stiffness measurement (LSM) in patients with different chronic liver diseases, and normal LSM is defined based on normal liver function tests or the absence of fibrosis. Very few studies have defined LSM based on completely normal liver biopsies. The current study was done to define the distribution of LSM values in individuals with normal liver biopsies. Methods: All prospective liver donors presenting to Medanta, the Medicity hospital between September 2020 and September 2021 fulfilling the eligibility criteria were included in this study. Results: A total of 63 donors (36 females and 27 males) were included in the study, 37 (58.7%) donors had normal liver biopsies, and 26 (41.2%) donors showed the presence of non-alcoholic fatty liver disease. LSM values in the normal liver histology group were 5.01 ± 1.99 kPa by the M probe and 5.34 ± 2.25 kPa by the XL probe. Even though the correlation was weak (r = 0.29, P = 0.03), M probe LSM correlated positively with body mass index. There was a good correlation between the LSM measured by the M probe and the XL probe (r = 0.73, P = <0.001). Conclusions: LSM value in the biopsy-proven normal liver histology group was 5.01 ± 1.99 by the M probe and 5.34 ± 2.25 by the XL probe.
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BACKGROUND: The study aimed to assess the morphology of post-living donor liver transplant (LDLT) anastomotic biliary strictures using cholangioscopy and assess the impact of morphology on its prognosis. METHODS: A single centre, prospective, observational study was conducted at a tertiary care teaching hospital from August 2014 to July 2016. Single operator cholangioscopy (SOC) was used to assess post-LDLT anastomotic biliary strictures at presentation in 24 patients. Analysis included demographic and biochemical characteristics, time to stricture development, endoscopic procedural details, time to remodelling and development of recurrence on follow-up. RESULTS: Two distinct patterns of strictures were identified, type I with minimal inflammatory changes and type II with severe inflammatory changes. Guidewire cannulation was successful in 23 out of 24 (95.8%) patients. There was no significant difference between the two types of strictures based on aetiology of liver disease, CTP and MELD scores, time taken for the development or laboratory parameters at presentation. However, type II strictures required more sessions of dilatation (4 vs. 2; P = 0.002), longer duration for resolution (282.5 vs. 201.5 days, P = 0.095) and more number of stents. CONCLUSIONS: Addition of cholangioscopy tends to improve stricture cannulation rates at ERCP. It offers a useful classification of post-LDLT strictures with prognostic and therapeutic significance. Type II strictures tend to require more sessions of endotherapy than type I strictures over a longer duration for remodelling.
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Colestasis , Trasplante de Hígado , Humanos , Trasplante de Hígado/efectos adversos , Colangiopancreatografia Retrógrada Endoscópica/efectos adversos , Constricción Patológica/etiología , Constricción Patológica/terapia , Donadores Vivos , Estudios Prospectivos , Resultado del Tratamiento , Colestasis/etiología , Colestasis/cirugía , Cateterismo , Stents/efectos adversos , Estudios RetrospectivosRESUMEN
Background and aims: Ultrasound of the liver is not good to pick up mild steatosis. Controlled attenuation parameter (CAP) evaluated in transient elastography (FibroScan) is widely available in India. However, data regarding the diagnostic accuracy and optimal cut-off values of CAP for diagnosing hepatic steatosis are scarce in Indian population. MRI-PDFF is an accurate technique for quantifying hepatic steatosis. Thus, this study examined the diagnostic accuracy and optimal cut-off values of CAP for diagnosing steatosis with MRI-PDFF as reference standard. Methods: A total of 137 adults underwent CAP and MRI-PDFF measurements prospectively. A subset of participants (n = 23) underwent liver biopsy as part of liver transplantation evaluation. The optimal cut-off values, area under the receiver operating characteristic (AUROC) curves, sensitivity, and specificity for CAP in detecting MRI-PDFF ≥5% and ≥10% were assessed. Results: The mean age and body mass index (BMI) were 44.2 ±10.4 years and 28.3 ±3.9 kg/m2, respectively. The mean hepatic steatosis was 13.0 ±7.7% by MRI-PDFF and 303 ±54 dB/m by CAP. The AUROC of CAP for detecting hepatic steatosis (MRI-PDFF ≥5%) was 0.93 (95% CI, 0.88-0.98) at the cut-off of 262 dB/m, and of MRI-PDFF ≥10% was 0.89 (95% CI, 0.84-0.94) at the cut-off of 295 dB/m. The CAP of 262 dB/m had 90% sensitivity and 91% specificity for detecting MRI-PDFF ≥5%, while the CAP of 295 dB/m had 86% sensitivity and 77% specificity for detecting MRI-PDFF ≥10%. Conclusions: The optimal cut-off of CAP for the presence of liver steatosis (MRI-PDFF ≥5%) was 262 dB/m in Indian individuals. This CAP cut-off was associated with good sensitivity and specificity to pick up mild steatosis.
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Immunomodulation has long been an adjunct approach in treating critically ill patients with sepsis, acute respiratory distress syndrome (ARDS), and acute pancreatitis (AP). Hyperactive immune response with immunopathogenesis leads to organ dysfunction and alters the clinical outcomes in critically ill. Though the immune response in the critically ill might have been overlooked, it has gathered greater attention during this novel coronavirus disease 2019 (COVID-19) pandemic. Modulating hyperactive immune response, the cytokine storm, especially with steroids, has shown to improve the outcomes in COVID-19 patients. In this review, we find that immune response pathogenesis in critically ill patients with sepsis, ARDS, and AP is nearly similar. The use of immunomodulators such as steroids, broad-spectrum serine protease inhibitors such as ulinastatin, thymosin alpha, intravenous immunoglobulins, and therapies such as CytoSorb and therapeutic plasma exchange may help in improving the clinical outcomes in these conditions. As the experience of the majority of physicians in using such therapeutics may be limited, we provide our expert comments regarding immunomodulation to optimize outcomes in patients with sepsis/septic shock, ARDS, and AP.
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BACKGROUND AND AIM: Type 2 diabetes (T2D) in associated with higher prevalence and worse outcomes of nonalcoholic fatty liver disease (NAFLD). However, data regarding the prevalence of clinically relevant liver fibrosis (CRLF) in Indian individuals with T2D are scarce. We investigated the prevalence of, and factors associated with, CRLF in Indians with T2D. METHODS: We conducted a prospective study of 601 consecutive adults with T2D. Steatosis was diagnosed using ultrasonography. Liver stiffness measurement (LSM) by transient elastography of ≥8.0 kPa was taken as cutoff suggesting CRLF. Individuals with LSM > 13.0 kPa underwent dynamic magnetic resonance imaging (MRI) of liver for detecting changes consistent with cirrhosis. RESULTS: The prevalence of steatosis was 84.2%. Higher body mass index (BMI, P = 0.022), alanine aminotransferase (ALT; P = 0.001), and lower high-density lipoprotein (HDL; P = 0.002) were independent factors associated with steatosis. The prevalence of CRLF was 28.2%. Higher BMI (P = 0.001), aspartate aminotransferase (AST; P < 0.0001), gamma-glutamyl transpeptidase (GGT; P < 0.0001), and concomitant hypertension (P = 0.03) were independent factors associated with CRLF. Elevated ALT and AST (≥40 units/L) levels were present in 70.6 and 51.6% individuals with CRLF, respectively. Thirty-one (7.2%) individuals had LSM > 13.0 kPa. Among them, 25 individuals underwent dynamic MRI of liver, which revealed features consistent with cirrhosis in 18 patients. CONCLUSION: CRLF, an established risk factor for cirrhosis and overall mortality, affects at least one out of four (25%) Indians with T2D. These results support screening of all patients with T2D and NAFLD for liver fibrosis.
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BACKGROUND AND AIM: Type 2 diabetes (T2D) and low skeletal muscle mass (SMM) are associated with increased risk of nonalcoholic fatty liver disease (NAFLD). However, data regarding the association between low SMM and NAFLD-related liver fibrosis in individuals with T2D are scarce. Therefore, we aimed to investigate the association between low SMM and liver fibrosis in individuals with T2D and NAFLD. METHODS: Controlled attenuation parameter (CAP) of ≥ 248 dB/m was taken as cutoff suggesting NAFLD. Clinically relevant liver fibrosis and advanced liver fibrosis were defined as liver stiffness measurement (LSM) by transient elastography (TE) of ≥ 8.0 and ≥ 9.6 kPa, respectively. SMM was measured using dual energy X-ray absorptiometry (DEXA). Low SMM was defined as appendicular SMM index of < 7.0 kg/m2 for men and < 5.4 kg/m2 for women. RESULTS: Of the 487 consecutive patients with T2D, 366 (75.1%) had NAFLD. Among individuals with NAFLD, 118 (32.2%) and 64 (17.5%) had clinically relevant liver fibrosis and advanced liver fibrosis, respectively. Low SMM was diagnosed in 78 (21.3%) individuals with NAFLD. Patients with low SMM were older (56.1 vs 52.8 years) and had longer duration of diabetes (10.3 vs 8.1 years). Low SMM was an independent risk factor associated with clinically relevant liver fibrosis (P = 0.002) and advanced liver fibrosis (P ≤ 0.0001). Associations between low SMM and clinically relevant- and advanced liver fibrosis were maintained even after sequential adjustment for confounding variables through the multivariate regression analysis. CONCLUSIONS: Low SMM is independently associated with liver fibrosis in individuals with T2D and NAFLD.
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Diabetes Mellitus Tipo 2 , Cirrosis Hepática , Músculo Esquelético , Enfermedad del Hígado Graso no Alcohólico , Diabetes Mellitus Tipo 2/epidemiología , Diagnóstico por Imagen de Elasticidad , Femenino , Humanos , Cirrosis Hepática/diagnóstico por imagen , Cirrosis Hepática/epidemiología , Masculino , Músculo Esquelético/diagnóstico por imagen , Músculo Esquelético/patología , Enfermedad del Hígado Graso no Alcohólico/epidemiología , Factores de RiesgoRESUMEN
BACKGROUND: Peroral cholangioscopy (POCS) of indeterminate biliary strictures aims to achieve a diagnosis through visual examination and/or by obtaining targeted biopsies under direct visualization. In this large, prospective, multinational, real-life experience of POCS-guided evaluation of indeterminate biliary strictures, we evaluated the performance of POCS in this difficult-to-manage patient population. METHODS: This prospective registry enrolled patients, with indeterminate biliary strictures across 20 centers in Asia, the Middle East, and Africa. The primary end points were the ability to visualize the lesion, obtain histological sampling when intended, and an assessment of the diagnostic accuracy of POCS for malignant strictures. Patients were followed for 6 months after POCS or until a definitive malignant diagnosis was made, whichever occurred first. RESULTS: 289 patients underwent 290 POCS procedures with intent to biopsy in 182 cases. The stricture/filling defect was successfully visualized in 286/290 (98.6â%), providing a visual diagnostic impression in 253/290 (87.2â%) and obtaining adequate biopsies in 169/182 (92.9â%). Procedure-related adverse events occurred in 5/289 patients (1.7â%). POCS influenced patient management principally by elucidating filling defects or the causes of bile duct stricture or dilation. The visual impression of malignancy showed 86.7â% sensitivity, 71.2â% specificity, 65.8â% positive and 89.4â% negative predictive value, and 77.2â% overall accuracy compared with final diagnosis. Histological POCS-guided samples showed 75.3â% sensitivity, 100â% specificity, 100â% positive and 77.1â% negative predictive value, and 86.5â% overall accuracy. CONCLUSION: In this large, real-life, prospective series, POCS was demonstrated to be an effective and safe intervention guiding the management of patients with indeterminate biliary strictures.
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Colestasis , Endoscopía del Sistema Digestivo , Asia , Colestasis/etiología , Constricción Patológica/etiología , Humanos , Sistema de RegistrosRESUMEN
The Indian Society of Gastroenterology developed this evidence-based practice guideline for management of gastroesophageal reflux disease (GERD) in adults. A modified Delphi process was used to develop this consensus containing 58 statements, which were generated by electronic voting iteration as well as face-to-face meeting and review of the supporting literature primarily from India. These statements include 10 on epidemiology, 8 on clinical presentation, 10 on investigations, 23 on treatment (including medical, endoscopic, and surgical modalities), and 7 on complications of GERD. When the proportion of those who voted either to accept completely or with minor reservation was 80% or higher, the statement was regarded as accepted. The prevalence of GERD in India ranges from 7.6% to 30%, being < 10% in most population studies, and higher in cohort studies. The dietary factors associated with GERD include use of spices and non-vegetarian food. Helicobacter pylori is thought to have a negative relation with GERD; H. pylori negative patients have higher grade of symptoms of GERD and esophagitis. Less than 10% of GERD patients in India have erosive esophagitis. In patients with occasional or mild symptoms, antacids and histamine H2 receptor blockers (H2RAs) may be used, and proton pump inhibitors (PPI) should be used in patients with frequent or severe symptoms. Prokinetics have limited proven role in management of GERD.
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Gastroenterología/normas , Reflujo Gastroesofágico/epidemiología , Reflujo Gastroesofágico/terapia , Guías de Práctica Clínica como Asunto , Adulto , Antiácidos/uso terapéutico , Consenso , Dieta/efectos adversos , Esofagitis/epidemiología , Esofagitis/etiología , Femenino , Reflujo Gastroesofágico/etiología , Infecciones por Helicobacter/complicaciones , Helicobacter pylori , Antagonistas de los Receptores H2 de la Histamina/uso terapéutico , Humanos , India/epidemiología , Masculino , Prevalencia , Inhibidores de la Bomba de Protones/uso terapéutico , Sociedades MédicasRESUMEN
ABSTRACT: Sweet syndrome,also known as acute febrile neutrophilic dermatosis , is one of the rare cutaneous association of ulcerative colitis.Only few cases of Sweet syndrome associated with ulcerative colitis have been reported in literature. We herein describe a case of young female with acute exacerbation of ulcerative colitis associated with erythematous , papular skin lesions which on biopsy were consistent with Sweet syndrome. Treatment with intravenous steroids resulted in improvement of ulcerative colitis and disappearance of cutaneous lesions. Cutaneous lesions of Sweet syndrome in ulcerative colitis parallel the bowel disease activity in majority of the cases but sometimes may precede the intestinal symptoms and rarely may appear after procto-colectomy for acute severe ulcerative colitis.Introduction.
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Colitis Ulcerosa/diagnóstico , Síndrome de Sweet/diagnóstico , Biopsia , Femenino , Humanos , Piel , Enfermedades de la PielRESUMEN
BACKGROUND: Peroral cholangioscopy (POCS) can be useful for difficult bile duct stone clearance. Large prospective multinational data on POCS-guided lithotripsy for clearing difficult bile duct stones in a single session of endoscopic retrograde cholangiopancreatography (ERCP) are missing. METHODS: Patients with difficult bile duct stones (defined as one or more of: largest stone diameter ≥â15âmm, failed prior attempt at stone clearance, impacted, multiple, hepatic duct location, or located above a stricture) were enrolled at 17 centers in 10 countries. The principal endpoint was stone clearance in a single ERCP procedure using POCS. RESULTS : 156 patients underwent 174 sessions of POCS-guided electrohydraulic or laser lithotripsy. Stone clearance had failed in a previous ERCP using traditional techniques in 124/156 patients (80â%), while 32â/156 patients (21â%) were referred directly to POCS-guided therapy based on preprocedural assessment of the difficulty of stone clearance. In 101/156 patients (65â%), there were impacted stones. POCS-guided stone clearance was achieved in a single POCS procedure in 125â/156 patients (80â%, 95â% confidence interval [CI] 73â%â-â86â%), and was significantly more likely for stones ≤â30âmm compared with >â30âmm (odds ratio 7.9, 95â%CI 2.4â-â26.2; Pâ=â0.002). Serious adverse events occurred in 3/156 patients (1.9â%, 95â%CI 0.4â%â-â5.5â%), and included pancreatitis, perforation due to laser lithotripsy, and cholangitis (nâ=â1 each), all resolved within 1 week. CONCLUSION: POCS-guided lithotripsy is highly effective for clearance of difficult bile duct stones in a single procedure and successfully salvages most prior treatment failures. It may also be considered first-line therapy for patients with difficult choledocholithiasis to avoid serial procedures.
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Colangiopancreatografia Retrógrada Endoscópica , Cálculos Biliares/cirugía , Litotricia/métodos , Cirugía Endoscópica por Orificios Naturales , Anciano , Femenino , Cálculos Biliares/diagnóstico , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Sistema de Registros , Resultado del TratamientoRESUMEN
Common variable immunodeficiency syndrome (CVID) is a heterogeneous disorder characterised by diminished levels of IgG, IgA and/or IgM, and recurrent bacterial infections. Sinopulmonary infections are most commonly reported followed by gastrointestinal (GI) infections. GI tract represents the largest immune organ with abundance of lymphoid cells, its involvement can manifest variably ranging from asymptomatic involvement to florid symptoms and signs. Diffuse nodular lymphoid hyperplasia (DNLH) of the GI tract is characterised by numerous small polypoid nodules of variable size in the small intestine, large intestine or both. It is commonly seen in association to immunodeficiency states such as CVID, IgA deficiency and chronic infections due to Giardia lamblia and Helicobacter pylori and cryptosporidiosis. Repetitive antigenic stimulation leads to lymphoid hyperplasia. We herein describe a case of DNLH of the intestine and another case of duodenal cytomegalovirus (CMV) infection associated with CVID.
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Inmunodeficiencia Variable Común/virología , Infecciones por Citomegalovirus/complicaciones , Diarrea/virología , Duodeno/patología , Hiperplasia/virología , Intestino Delgado/patología , Trastornos Linfoproliferativos/virología , Adulto , Antivirales/uso terapéutico , Inmunodeficiencia Variable Común/tratamiento farmacológico , Inmunodeficiencia Variable Común/fisiopatología , Infecciones por Citomegalovirus/fisiopatología , Duodeno/virología , Endoscopía del Sistema Digestivo , Ganciclovir/uso terapéutico , Humanos , Hiperplasia/tratamiento farmacológico , Hiperplasia/fisiopatología , Inmunoglobulinas Intravenosas/uso terapéutico , Intestino Delgado/virología , Trastornos Linfoproliferativos/tratamiento farmacológico , Trastornos Linfoproliferativos/fisiopatología , Masculino , Persona de Mediana Edad , Resultado del TratamientoRESUMEN
BACKGROUND AND STUDY AIMS: Endoscopic management using standard accessories is the preferred modality for treatment of benign biliary strictures. However, with difficult strictures, there is frequently failure of endoscopic therapy. We are reporting our experience regarding use of a standard diathermic dilator (cystotome) to aid in stricture dilatation and stent placement in patients with difficult strictures. PATIENTS AND METHODS: Data were analyzed from January 2014 to January 2017âat a single tertiary care center in North India. Total 25 patients were included. RESULTS: The mean age was 45 years (varying from 38â-â55 years). Of the 25 patients with difficult strictures, 14 (56â%) were male and 11 (44â%) were female. Further, of these, 19 had biliary and 6 had pancreatic strictures. The average time of diathermic current application was 3.5 seconds (ranging 3â-â5 seconds). Technical and clinical success were achieved in 100â% of cases. None of the patients had any procedure-related (early or delayed) major complications. CONCLUSION: The cystotome is an extremely safe and useful accessory in benign biliary and pancreatic strictures, whereas conventional methods to negotiate stricture have failed.
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Achalasia secondary to underlying neoplasm is a rare entity. Early recognition of secondary achalasia is important as its treatment involves management of underlying malignancy, while treatment of primary achalasia mainly involves lowering the lower oesophageal sphincter pressure with pneumatic dilatation or Heller's myotomy. We discuss an interesting case of achalasia secondary to non-Hodgkin's lymphoma.
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Trastornos de Deglución/diagnóstico , Endoscopía del Sistema Digestivo , Acalasia del Esófago/diagnóstico , Neoplasias Esofágicas/diagnóstico , Linfoma no Hodgkin/diagnóstico , Síndromes Paraneoplásicos/diagnóstico , Anticuerpos Monoclonales de Origen Murino , Protocolos de Quimioterapia Combinada Antineoplásica , Ciclofosfamida , Trastornos de Deglución/etiología , Trastornos de Deglución/patología , Doxorrubicina , Acalasia del Esófago/complicaciones , Acalasia del Esófago/fisiopatología , Neoplasias Esofágicas/tratamiento farmacológico , Neoplasias Esofágicas/fisiopatología , Esofagoscopía , Humanos , Linfoma no Hodgkin/tratamiento farmacológico , Linfoma no Hodgkin/fisiopatología , Masculino , Persona de Mediana Edad , Síndromes Paraneoplásicos/tratamiento farmacológico , Síndromes Paraneoplásicos/fisiopatología , Prednisona , Rituximab , Resultado del Tratamiento , VincristinaRESUMEN
BACKGROUND AND AIM: There is paucity of data about endoscopic pancreatic sphincteroplasty (EPS) after endoscopic pancreatic sphincterotomy (EPST) in the treatment of chronic pancreatitis. The aim of this study was to establish the indications for EPS, complications related to it, and to examine its effectiveness in managing chronic pancreatitis after a year of follow-up. METHODS: We evaluated the safety and efficacy of pancreatic balloon dilation coupled with sphincterotomy for the treatment of chronic pancreatitis. The technical success rate of balloon dilation, stone clearance, frequency of pancreatic stenting, and procedure-related adverse events were recorded. RESULTS: Out of 580 patients who underwent pancreatic endotherapy between July 2014 and February 2016, 80 patients underwent EPS. The mean age of these 80 patients was 34â±â11 years, and 80â% (nâ=â64) were males. The common indications were removal of large radiolucent stones in 31 patients; unyielding radiopaque stones post extracorporeal shock wave lithotripsy (ESWL) in 20 patients, and pancreatic duct stricture combined with stones in 29 patients. EPS could be successfully completed in 98.75â% of patients. Complete ductal clearance in a single session was achieved in only 25 patients, while 26 patients required two sessions. There were two adverse events of pain requiring admission for more than 24 hours and one procedure related bleeding, all of which were managed conservatively. The patients had an average follow-up of 8 months (6â-â12 months) and all the patients were pain free. CONCLUSIONS: Endoscopic pancreatic sphincteroplasty is a relatively safe procedure with a low incidence of complications and a high rate of treatment success.
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BACKGROUND: Large portosystemic shunts (PSSs) may lead to recurrent encephalopathy in patients with cirrhosis and embolization of these shunts may improve encephalopathy. MATERIAL AND METHODS: Five patients underwent balloon-occluded retrograde transvenous obliteration (BRTO) or plug-assisted retrograde transvenous obliteration (PARTO) of a large PSS at our center in last 2 years for recurrent hepatic encephalopathy (HE) at a tertiary care center at north India. Data are shown as number and mean ± SD. None of these patients had Child's C cirrhosis or presence of large ascites/large varices. RESULTS: Five patients (all males), aged 61 ± 7 years, underwent BRTO or PARTO for recurrent HE and presence of lienorenal (n = 4) or mesocaval shunt (n = 1). The etiology of cirrhosis was cryptogenic/non-alcoholic steatohepatitis in 3, and alcohol and hepatitis B in one each. All patients had Child's B cirrhosis; Child's score was 8.6 ± 0.5, model for end-stage liver disease (MELD) score was 13.4 ± 2.3. One patient had mild ascites; 3 patients had small esophageal varices before procedure. Sclerosants (combination of air, sodium tetradecyl sulphate, and lipiodol) were used in two patients, endovascular occlusion plugs were used in two patients, and both sclerosants and endovascular occlusion plug were used in one patient. Embolization of minor outflow veins to allow for stable deposition sclerosants in dominant shunt was done using embolization coils and glue in two patients. One patient needed 2 sessions. The pre-procedure ammonia was 127 ± 35 which decreased to 31 ± 17 after the shunt embolization. There was no recurrence of encephalopathy in any of these patients. One patient was lost to follow-up at 6 months; others are doing well at 6 months (n = 2), 10 months (n = 1) and 2 years (n = 1). None of these patients developed further decompensation in the defined follow-up period. CONCLUSION: Good results can be obtained in selected patients after embolization of large PSS for recurrent HE.
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BACKGROUND AND STUDY AIM: Different types of endoscopic ultrasound (EUS)-guided fine-needle aspiration (FNA) techniques are used in clinical practice; the best method in terms of outcome has not been determined. The aim of the study was to compare the diagnostic adequacy of aspirated material, and the cytopathological and EUS morphological features between capillary action, suction, and no-suction FNA methods. PATIENTS AND METHODS: This was a prospective, single-blinded, randomized study conducted at a tertiary care hospital. Patients were randomized to the three groups: capillary action, suction, and no suction. A total of 300 patients were included, with 100 patients in each arm. RESULTS: A total of 300 patients (195 males) underwent EUS-FNA of 235 lymph nodes and 65 pancreatic masses (distribution not statistically different between the groups). The mean age was 52â±â14 years. A 22 gauge needle was used in the majority (93â%) of procedures. There was no statistical difference between the three groups regarding lymph node size at the largest axis and ratio, type of needle, echo features, echogenicity, calcification, necrosis, shape, borders (lymph nodes), number of passes, and cellularity. Diagnostic adequacy of the specimen was 91â%, 91â%, and 94â% in the capillary, suction, and no suction groups, respectively ( P â=â0.67). Significantly more slides and blood clots were generated by the suction method compared with the other methods. CONCLUSION: The capillary action, suction, and no suction methods of EUS-FNA are similar in terms of diagnostic adequacy of the specimen. The suction method has the disadvantages of causing more bleeding and generating more slides.