Publications by authors named "Ashok Dalal"

18 Publications

  • Page 1 of 1

Spontaneous giant biloma resulting from multifocal left hepatic duct perforation.

Indian J Gastroenterol 2021 Mar 5. Epub 2021 Mar 5.

Department of Gastroenterology, G B Pant Hospital, New Delhi, 110 002, India.

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http://dx.doi.org/10.1007/s12664-021-01154-yDOI Listing
March 2021

COVID-19 Rapid Antigen Test: Role in Screening Prior to Gastrointestinal Endoscopy.

Clin Endosc 2021 Mar 4. Epub 2021 Mar 4.

Department of Gastroenterology, Govind Ballabh Pant Institute of Postgraduate Medical Education and Research (GIPMER), New Delhi, India.

Background/aims: The severe acute respiratory syndrome coronavirus 2 pandemic has affected the gastrointestinal (GI) endoscopy units globally owing to the risk of transmission. We present our data on the use of rapid antigen test (RAT) as a screening tool prior to endoscopy to prevent the transmission of coronavirus disease (COVID-19).

Methods: This study was a retrospective analysis of patients who underwent any GI endoscopic procedure from July 2020 to October 2020 at a tertiary referral center in New Delhi, India. All patients underwent screening for COVID-19 using RAT, and endoscopy was performed only when the RAT was negative. The data are presented as numbers and percentages.

Results: A total of 3,002 endoscopic procedures were performed during the study period. Only one endoscopic procedure was performed in a COVID-19 positive patient. A total of 53 healthcare workers were involved in conducting these procedures. Only 2 healthcare workers (3.8%) were diagnosed COVID-19 positive, presumably due to community-acquired infection, during this period.

Conclusions: The COVID-19 RAT is easily usable as a simple screening tool prior to GI endoscopy during the COVID-19 pandemic.
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http://dx.doi.org/10.5946/ce.2020.295DOI Listing
March 2021

Kaposiform haemangioendothelioma of duodenum in a neonate.

BMJ Case Rep 2021 Feb 19;14(2). Epub 2021 Feb 19.

Department of Gastroenterology, GB Pant Hospital, New Delhi, India

Kaposiform haemangioendothelioma, an endothelial borderline tumour, is typically seen in childhood involving extremities. It has been closely associated with a consumptive coagulopathy state, Kasabach-Merritt phenomenon (KMP). Extracutaneous involvement is uncommon. Intestinal involvement is quite uncommon and can masquerade as an acute abdomen. A 24-day-old neonate presented with bilious vomiting and fever for 5 days. Sections from the resected gangrenous duodenum contained a submucosal tumour composed of infiltrating nodules of slit-like or crescentic CD34-positive spindled-to-flattened endothelial-lined vascular spaces along with zones of fibrosis. No nuclear pleomorphism or necrosis identified. The findings were classic example of kaposiform haemangioendothelioma with an absence of any deranged coagulation profile. The index case raises interest given its congenital incidental presentation at an uncommon site, like duodenum, and absence of coexistent KMP.
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http://dx.doi.org/10.1136/bcr-2020-239527DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7898843PMC
February 2021

Abdominal CT in a pregnant woman: Bane or boon?

JGH Open 2021 Jan 7;5(1):155-156. Epub 2020 Dec 7.

Department of Gastroenterology GB Pant Hospital New Delhi India.

Would you ever purposefully advise an abdominal computed tomography scan in a pregnant woman? We present the case of a pregnant woman who presented with hematochezia requiring multiple transfusions.
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http://dx.doi.org/10.1002/jgh3.12471DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7812491PMC
January 2021

Mucin-filled CBD, difficult to manage cholangitis.

BMJ Case Rep 2021 Jan 11;14(1). Epub 2021 Jan 11.

Gastroenterology, GB Pant Hospital, New Delhi, India

Intraductal papillary mucinous neoplasms (IPMNs) are mucin-secreting cystic neoplasm of pancreas. They have a malignant potential. They are usually localised to the pancreas but occasionally can involve surrounding structures (1.9%-6.6%), like bile duct and duodenum, and are labelled as IPMN with invasion. Jaundice as a manifestation of IPMN is not common (4.5%). It can present as jaundice as a result of invasion of common bile duct (CBD) resulting in stricture formation or uncommonly as a result of fistulising to CBD with resultant obstruction of CBD by thick mucin secreted by this tumour. As only few cases (around 23) of mucin-filled CBD are reported in the literature. We are presenting our experience in dealing a rare case of obstructive jaundice caused by IPMN fistulising into CBD, highlighting the difficulties faced in managing such case, especially with regards to biliary drainage and what can be the optimum management in such cases.
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http://dx.doi.org/10.1136/bcr-2020-238363DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7802659PMC
January 2021

Erythrophagocytosis in colonic mucosa: real-time amazing display.

BMJ Case Rep 2020 Dec 12;13(12). Epub 2020 Dec 12.

Gastroenterology, GB Pant Hospital, New Delhi, Delhi, India

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http://dx.doi.org/10.1136/bcr-2020-238921DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7735084PMC
December 2020

Mediastinal dumbbell pancreatic pseudocyst: An amazing cause of dysphagia.

Dig Liver Dis 2020 Oct 30. Epub 2020 Oct 30.

Department of Gastroenterology, GB Pant Hospital, New Delhi, India.

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http://dx.doi.org/10.1016/j.dld.2020.10.008DOI Listing
October 2020

A rare cause of recurrent acute pancreatitis.

JGH Open 2020 Oct 13;4(5):1019. Epub 2020 Jul 13.

Department of Gastroenterology, Academic Block GB Pant Hospital New Delhi India.

Annular pancreas is a rare entity. It clinically presents with intestinal obstruction. We present a case of a young female with incomplete annular pancreas presented with recurrent acute pancreatitis.
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http://dx.doi.org/10.1002/jgh3.12391DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7578320PMC
October 2020

Triple-A Syndrome: A rare cause of pediatric achalasia.

Dig Liver Dis 2020 Sep 5. Epub 2020 Sep 5.

Department of Gastroenterology, GB Pant Hospital, New Delhi 110002, India.

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http://dx.doi.org/10.1016/j.dld.2020.08.026DOI Listing
September 2020

Choledocholithiasis in autosomal dominant polycystic kidney disease.

Dig Liver Dis 2021 Jan 16;53(1):127-128. Epub 2020 Jun 16.

Department of Gastroenterology, GB Pant Hospital, New Delhi 110002, India.

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http://dx.doi.org/10.1016/j.dld.2020.05.036DOI Listing
January 2021

Multifocal gastric metastasis of malignant melanoma: An ominous endoscopic appearance: Gastric metastasis of malignant melanoma.

Dig Liver Dis 2020 12 2;52(12):1512. Epub 2020 Jun 2.

Department of Gastroenterology, GB Pant Hospital, New Delhi (India)-110002.

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http://dx.doi.org/10.1016/j.dld.2020.05.011DOI Listing
December 2020

Isolated Rectal Tuberculosis With Multiple Fistulae.

Clin Gastroenterol Hepatol 2020 May 22. Epub 2020 May 22.

Department of Gastroenterology, GB Pant Hospital, New Delhi, India.

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http://dx.doi.org/10.1016/j.cgh.2020.05.031DOI Listing
May 2020

Role of linear endosonography in the diagnosis of biopsy-negative malignant esophageal strictures: Exploring the unexplored.

JGH Open 2020 Apr 18;4(2):113-116. Epub 2019 Jul 18.

Department of Gastroenterology G B Pant Institute of Postgraduate Medical Education and Research New Delhi India.

Background And Aim: Endoscopic biopsy is standard for the diagnosis of esophageal malignancy. However, few cases present with smooth stricture with repetitive negative biopsy results. We aimed to use linear endoscopic ultrasound (EUS) and fine-needle aspiration (FNA) in the diagnosis of biopsy-negative suspected malignant esophageal strictures.

Methods: We retrospectively analyzed the data from August 2017 to December 2018 of biopsy-negative esophageal strictures. All adult patients with twice-negative biopsies and with smooth overlying esophageal mucosa on endoscopy were included. Clinical, epidemiological, endoscopic, imaging, and EUS findings were noted and analyzed.

Results: Eighteen patients underwent EUS for suspicion of malignant esophageal stricture. Seven were excluded as they were submucosal tumors. Eleven patients showed the presence of malignancy on EUS FNA samples. Nine were males. Computed tomography showed esophageal wall thickening in eight (16-38 mm) and esophageal mass in three patients. EUS showed loss of a normal five-layered wall structure of the esophagus in all patients. Fine-needle aspiration cytology demonstrated squamous cell carcinoma ( = 4), adenocarcinoma ( = 4), poorly differentiated carcinoma ( = 2), and neuroendocrine carcinoma ( = 1). There were no complications.

Conclusion: EUS with FNA is effective and safe for the diagnosis of biopsy-negative malignant esophageal strictures.
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http://dx.doi.org/10.1002/jgh3.12225DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7144779PMC
April 2020

Nonsurgical management of gastroduodenal tuberculosis: Nine-year experience from a tertiary referral center.

Endosc Int Open 2019 Oct 1;7(10):E1248-E1252. Epub 2019 Oct 1.

Department of Pathology, G B Pant Hospital, New Delhi, India.

 Gastroduodenal tuberculosis (GDTB) is an uncommon disease. Surgery has been standard of care both for diagnosis and management of GDTB. The aim of this study was to evaluate the efficacy of non-surgical management of GDTB using a combination of anti-tuberculous therapy (ATT) along with endoscopic dilatation of the tuberculous stricture.  Patients suspected to have gastroduodenal TB were evaluated: clinical, endoscopic, radiological, and histopathological data were recorded. Patients in whom a definite diagnosis of tuberculosis could not be confirmed on mucosal biopsies underwent endoscopic mucosal resection (EMR). Patients were treated with ATT and endoscopic dilatation was done if indicated. Patients were followed up to evaluate clinical, radiological and endoscopic response.  Over a 9-year period from 2009 to 2017, 52 patients (mean age 28.5yrs) were diagnosed with GDTB. The most common presenting symptoms were vomiting (n = 51, 98 %) and weight loss (n = 52,100 %). The most common anatomical site of involvement was D1-D2 junction (n = 22, 42 %). Histopathological diagnosis could be made in 43 patients (82.6 %); 36 (69 %) on mucosal biopsies and in 7 of 10 patients (70 %) who underwent snare biopsy/EMR. Endoscopic dilatation was done in 37 patients (71 %) and median dilatation sessions were two. Failure of endotherapy occurred in four patients (7.6 %). All responders had complete amelioration of symptoms after 4 to 6 weeks of combination therapy. Median period of follow-up was 23.5 months and none of the patients reported any recurrence of symptoms.  ATT and endoscopic dilatation combined has a high success rate in management of GDTB and should be considered the standard of care.
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http://dx.doi.org/10.1055/a-0957-2754DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6773584PMC
October 2019

Tissue Xpert® MTB/RIF Assay in Peritoneal Tuberculosis: To be (Done) or Not to be (Done).

Cureus 2019 Jun 26;11(6):e5009. Epub 2019 Jun 26.

Gastroenterology, G B Pant Institute of Postgraduate Medical Education and Research, New Delhi, IND.

Introduction Peritoneal tuberculosis (PTB) is a paucibacillary disease with poor mycobacterial yield in ascitic fluid. The Xpert® MTB/RIF assay (Gene Xpert) is a new tool for the diagnosis of tuberculosis (TB) and has not yet been studied on peritoneal tissue. The present study aimed to investigate the yield of the Xpert® MTB/RIF assay on peritoneal tissue obtained at peritoneoscopy. Methods This is a retrospective study and the data were collected from hospital records. The patients who underwent peritoneoscopy along with Xpert® MTB/RIF assay on peritoneal tissue were included in this study. Those with proven PTB were considered as cases while those with other diagnoses as controls. Using the reference standard of TB diagnosis, sensitivity, specificity, and accuracy of Xpert® MTB/RIF assay were calculated. Results Total of 36 patients was analyzed in this study: 28 as cases and eight as controls. Peritoneoscopy was carried out for diagnosis and biopsy. Histopathology in cases revealed caseating granulomas in 16 while 11 had non-caseating granulomas. Nine patients showed acid-fast bacillus positivity on peritoneal tissue. The most common finding on peritoneoscopy was tubercles with adhesions (n = 14, 50%), followed by tubercles only (n = 12, 42.9%). Xpert® MTB/RIF assay was positive in 17 (60.7%) patients with a sensitivity of 60.71%, specificity of 100%, and an accuracy of 69.44%. Two patients expressed rifampicin resistance. Conclusion Xpert® MTB/RIF assay on peritoneal tissue has fair sensitivity and excellent specificity. The multidrug resistance and the ability to provide results rapidly make it clinically useful.
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http://dx.doi.org/10.7759/cureus.5009DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6713244PMC
June 2019

Brain Fogginess and SIBO: A Link or Just a Mirage?

Clin Transl Gastroenterol 2018 09 20;9(9):184. Epub 2018 Sep 20.

Department of Gastroenterology, GB Pant Hospital, New Delhi, 110002, India.

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http://dx.doi.org/10.1038/s41424-018-0055-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6147951PMC
September 2018

Aetiological spectrum of benign gastric outlet obstruction in India: new trends.

Trop Doct 2016 Oct 15;46(4):186-191. Epub 2016 Jan 15.

Senior Resident, Department of Gastroenterology, GB Pant Hospital, New Delhi, India.

There is a paucity of data on the spectrum of benign gastric outlet obstruction in India. Our aim was to evaluate its spectrum and to identify the subgroup which would be most amenable to endoscopic therapy. We studied 64 patients whose aetiology revealed in approximately equal proportions: corrosive injury; gastroduodenal tuberculosis (TB); and peptic ulcer disease. The median number of endoscopic dilations required was two for TB, four for peptic ulcer disease and five for corrosive injury. Gastroduodenal TB and corrosive injury appear now to be more, or at least as, common as peptic ulcer disease as causes of benign gastric outlet obstruction in India. Gastroduodenal TB responds best to endoscopic therapy.
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http://dx.doi.org/10.1177/0049475515626032DOI Listing
October 2016