Publications by authors named "Rakesh Kochhar"

280 Publications

Computed Tomography Findings in Intraabdominal Hypertension in Patients with Acute Pancreatitis.

Indian J Radiol Imaging 2021 Jan 23;31(1):150-156. Epub 2021 May 23.

Department of Gastroenterology, PGIMER, Chandigarh, India.

 Intraabdominal hypertension (IAH) in acute pancreatitis (AP) may reduce tissue perfusion and impair organ function and has been shown to portend poor prognosis. We investigated the computed tomography (CT) findings in patients with AP with IAH.  This retrospective study comprised of consecutive patients with AP from June 2016 to June 2018 in whom intraabdominal pressure (IAP) was measured. The patients who underwent a contrast-enhanced CT within 7 days of IAP measurement were included. Using a cutoff of 12 mm Hg for IAP, the patients were divided into IAH and non-IAH groups. Measures of severity and clinical outcome were evaluated. CT parameters were compared between the groups.  The IAH group comprised of 41 patients, while there were 20 patients in the non-IAH group. The IAH group was characterized by severe disease, increased incidence of organ failure, increased requirement for drainage and surgery, prolonged hospital and intensive care unit stay. The mortality was not significantly different between the two groups. On univariate analysis, the CT features that were found to be significantly different between the two groups were the presence of collection ( = 0.036), the maximum dimension of collection ( = 0.004), volume of collection ( = 0.019), biliary dilatation ( = 0.011), and the presence of moderate-to-severe pleural effusion ( = 0.009). On multivariate analysis, all these parameters except biliary dilatation were found to be statistically significant.  CT findings in patients with AP may suggest IAH. This can be used as an additional marker for severity of AP.
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http://dx.doi.org/10.1055/s-0041-1729768DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8299494PMC
January 2021

Non-steroidal anti-inflammatory drugs, intravenous fluids, pancreatic stents, or their combinations for the prevention of post-endoscopic retrograde cholangiopancreatography pancreatitis: a systematic review and network meta-analysis.

Lancet Gastroenterol Hepatol 2021 Jun 29. Epub 2021 Jun 29.

Division of Gastroenterology, Johns Hopkins Medical Institutions, Baltimore, MD, USA.

Background: Non-steroidal anti-inflammatory drugs (NSAIDs), intravenous fluid, pancreatic stents, or combinations of these have been evaluated in randomised controlled trials (RCTs) for the prevention of post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis, but the comparative efficacy of these treatments remains unclear. Our aim was to do an exploratory network meta-analysis of previous RCTs to systematically compare the direct and indirect evidence and rank NSAIDs, intravenous fluids, pancreatic stents, or combinations of these to determine the most efficacious method of prophylaxis for post-ERCP pancreatitis.

Methods: We searched PubMed, Embase, and the Cochrane Central Register from inception to Nov 15, 2020, for full-text RCTs that evaluated the efficacy of NSAIDs, pancreatic stents, intravenous fluids, or combinations of these for post-ERCP pancreatitis prevention in adult (aged ≥18 years) patients undergoing ERCP. Summary data from intention-to-treat analyses were extracted from published reports. We analysed incidence of post-ERCP pancreatitis across studies using network meta-analysis under the frequentist framework, obtaining pairwise odds ratios (ORs) and 95% CIs. We used the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system for the confidence rating. This study is registered with PROSPERO, CRD42020172606.

Findings: We identified 1503 studies, of which 55 RCTs evaluating 20 interventions in 17 062 patients were included in the network meta-analysis. The mean incidence of post-ERCP pancreatitis in the placebo or active control group was 12·2% (95% CI 11·4-13·0). Normal saline plus rectal indometacin (OR 0·02, 95% CI 0·00-0·40), intramuscular diclofenac 75 mg (0·24, 0·09-0·69), intravenous high-volume Ringer's lactate plus rectal diclofenac 100 mg (0·30, 0·16-0·55), intravenous high-volume Ringer's lactate (0·31, 0·12-0·78), 5-7 Fr pancreatic stents (0·35, 0·26-0·48), rectal diclofenac 100 mg (0·36, 0·25-0·52), 3 Fr pancreatic stents (0·47, 0·26-0·87), and rectal indometacin 100 mg (0·60, 0·50-0·73) were all more efficacious than placebo for preventing post-ERCP pancreatitis in pairwise comparisons. 5-7 Fr pancreatic stents (0·59, 0·41-0·84), intravenous high-volume Ringer's lactate plus rectal diclofenac 100 mg (0·49, 0·26-0·94), intravenous standard-volume normal saline plus rectal indometacin 100 mg (0·04, 0·00-0·66), and rectal diclofenac 100 mg (0·59, 0·40-0·89) were more efficacious than rectal indometacin 100 mg. The GRADE confidence rating was low to moderate for 98·3% of the pairwise comparisons.

Interpretation: This systematic review and network meta-analysis summarises the available literature on NSAIDs, pancreatic stents, intravenous fluids, or combinations of these for prophylaxis of post-ERCP pancreatitis. Rectal diclofenac 100 mg is the best performing rectal NSAID in this network meta-analysis. Combinations of prophylaxis might be more effective, but there is little evidence. These findings help to establish prophylaxis of post-ERCP pancreatitis for future research and practice, and could reduce costs and increase adoption of prophylaxis.

Funding: None.
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http://dx.doi.org/10.1016/S2468-1253(21)00170-9DOI Listing
June 2021

Best practices of handling, processing, and interpretation of small intestinal biopsies for the diagnosis and management of celiac disease: A joint consensus of Indian association of pathologists and microbiologists and Indian society of gastroenterology.

Indian J Pathol Microbiol 2021 Jun;64(Supplement):S8-S31

Department of Pathology, MLN Medical College, Allahabad, Uttar Pradesh, India.

The Indian Association of Pathologists and Microbiologists (IAPM) and Indian Society of Gastroenterology (ISG) decided to make a joint consensus recommendation for handling, processing, and interpretation of SI biopsies for the diagnosis and management of celiac disease (CD) recognizing the inhomogeneous practice of biopsy sampling, orientation, processing, and interpretation. A modified Delphi process was used to develop this consensus document containing a total of 42 statements and recommendations, which were generated by sharing the document draft, incorporating expert's opinion, followed by three cycles of electronic voting as well as a full-day face-to-face virtual ZOOM meeting and review of supporting literature. Of the 42 statements, 7 statements are on small intestinal (SI) biopsy in suspected patients of CD, site and the number of biopsies; 7 on handling, fixative, orientation, processing, and sectioning in pathology laboratories; 2 on histological orientation; 13 statements on histological interpretation and histological grading; 3 on the assessment of follow-up biopsies; 2 statements on gluten-free diet (GFD)-nonresponsive CD; 4 on challenges in the diagnosis of CD; 2 statements each on pathology reporting protocol and training and infrastructure in this area. The goal of this guideline document is to formulate a uniform protocol agreed upon both by the experienced pathologists and gastroenterologists to standardize the practice, improve the yield of small bowel biopsy interpretation, patients' compliance, overall management in CD, and generate unified data for patient care and research in the related field.
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http://dx.doi.org/10.4103/IJPM.IJPM_1405_20DOI Listing
June 2021

Should patients with unresectable gallbladder cancer with hilar involvement undergo unilateral or bilateral percutaneous biliary drainage in the setting of cholangitis?

Clin Exp Hepatol 2021 Mar 25;7(1):7-12. Epub 2021 Mar 25.

Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India.

Aim Of The Study: This study aimed to evaluate the outcomes of patients with unresectable gallbladder cancer (GBC) with hilar involvement and cholangitis undergoing percutaneous transhepatic biliary drainage (PTBD).

Material And Methods: This retrospective study comprised consecutive patients with unresectable GBC with cholangitis who underwent PTBD. The procedures were categorized as unilateral or bilateral. Bilateral PTBD was classified as simultaneous or sequential. The mean reduction in bilirubin at two weeks was recorded. Complications and mean overall survival were also recorded.

Results: Thirty-three patients (mean age 54.5 years, 12 males) were included. Thirty patients underwent unilateral drainage. Sequential drainage of the contralateral system was performed in 11 patients. Simultaneous bilateral PTBD was performed in 3 patients. PTBD was technically successful in all patients. Mean reduction in bilirubin was 41.5% in the unilateral group. The fall of bilirubin in the simultaneous bilateral PTBD group was 39%. The mean follow-up duration was 36.5 days. No major complications were encountered. At the last follow-up, 7 patients were alive. The mean overall survival was 34.6 days.

Conclusions: Patients with unresectable GBC and cholangitis frequently require bilateral drainage. However, prospective studies should be performed to evaluate whether a sequential or simultaneous PTBD should be performed.
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http://dx.doi.org/10.5114/ceh.2021.104674DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8122101PMC
March 2021

ALK+ Anaplastic large cell lymphoma with extensive cardiac involvement: A rare case report and review of the literature.

Autops Case Rep 2021 Jan 28;11:e2020231. Epub 2021 Jan 28.

Postgraduate Institute of Medical Education and Research, Department of Gastroenterology, Chandigarh, India.

Cardiac lymphoma is a rare entity. In this setting, the secondary involvement of the heart is far more frequent than the primary cardiac lymphoma. Herein, we present an autopsy case of a disseminated anaplastic lymphoma kinase (ALK)-positive anaplastic large cell lymphoma with a dominant mediastinal involvement. Extensive cardiac infiltration with the near replacement of the myocardial wall by the neoplastic cells was observed. A total of nine isolated case reports of anaplastic large cell lymphoma with cardiac involvement were found in the English-language literature, and a widespread cardiac and thymic infiltration by the systemic ALK-positive anaplastic large cell lymphoma has not been documented. An incidental regenerative nodule was also identified in the liver. The patient died of pulmonary thromboembolism and cardiac arrest.
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http://dx.doi.org/10.4322/acr.2020.231DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8020592PMC
January 2021

Sham Feeding Induced Gastric Acid Secretion in Patients with Caustic Induced Esophageal Stricture.

Dysphagia 2021 Apr 27. Epub 2021 Apr 27.

Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.

Caustic ingestion can lead to structural changes in the upper gastro-intestinal tract. However, there is limited data on the effect of caustic ingestion on gastric secretion. This study was planned to determine changes in gastric acid output after sham feeding in patients with caustic induced esophageal stricture and to compare it with healthy controls. It was a prospective study done at tertiary care center in North India. Consecutive patients with caustic induced esophageal stricture were evaluated for the study. Gastric secretory function was estimated in the basal state and after modified sham feeding. These results were compared with age-matched controls. The mean age of the included patients (n = 18) was 30.11 ± 9.19 years and 13 patients were male. 16 (88%) patients had history of acid ingestion. Patients with caustic sequelae had significantly lower basal and stimulated acid secretion compared to controls (n = 10) (5.84 ± 2.44 mmol/hr; p < 0.01 and 17.16 ± 7.53 mmol/hr; p < 0.01; respectively). Patients with lower esophageal stricture (n = 8) had significantly lower increase in acid output compared to patients with stricture elsewhere in esophagus (0.20 ± 0.3 vs. 2.31 ± 1.74 mmol/hr, p < 0.01). Patients with lower esophageal involvement had significantly lower stimulated acid secretion and increase in acid secretion compared to controls (4.74 ± 4.67 vs. 17.16 ± 7.53 mmol/hr; p < 0.01 and 20 ± 0.3 vs. 2.09 ± 0.88 mmol/hr; p < 0.01; respectively).
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http://dx.doi.org/10.1007/s00455-021-10285-5DOI Listing
April 2021

Mortality in acute pancreatitis with persistent organ failure is determined by the number, type, and sequence of organ systems affected.

United European Gastroenterol J 2021 Mar;9(2):139-149

Department of Biostatistics, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.

Background: Persistent organ failure (POF) is the strongest determinant of mortality in acute pancreatitis (AP). There is a paucity of data regarding the impact of different POF attributes on mortality and the role of different characteristics of systemic inflammatory response syndrome (SIRS) in the risk of developing POF.

Objective: We aimed to assess the association of POF dynamic features with mortality and SIRS characteristics with POF.

Methods: We studied 1544 AP subjects prospectively enrolled at 22 international centers (APPRENTICE consortium). First, we estimated the association of onset, duration, and maximal score of SIRS with POF. Then, we evaluated the risk of mortality based on POF onset, duration, number, type, and sequence of organs affected. Analyses were adjusted for potential confounders.

Results: 58% had SIRS, 11% developed POF, and 2.5% died. Early SIRS, persistent SIRS, and maximal SIRS score ≥ 3 were independently associated with higher risk of POF (p < 0.05). Mortality risk in POF was higher with two (33%, odds ratio [OR] = 10.8, 3.3-34.9) and three (48%, OR = 20.2, 5.9-68.6) organs failing, in comparison to single POF (4%). In subjects with multiple POF, mortality was higher when the cardiovascular and respiratory systems failed first or concurrently as compared to when the renal system failed first or concurrently with other organ (p < 0.05). In multivariate regression model, the number and sequence of organs affected in POF were associated with mortality (p < 0.05). Onset and duration of POF had no impact mortality.

Conclusion: In AP patients with POF, the risk of mortality is influenced by the number, type, and sequence of organs affected. These results are useful for future revisions of AP severity classification systems.
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http://dx.doi.org/10.1002/ueg2.12057DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8259236PMC
March 2021

Use of thiopurines in inflammatory bowel disease: an update.

Intest Res 2021 Apr 15. Epub 2021 Apr 15.

Department of Gastroenterology, Dayanand Medical College and Hospital, Ludhiana, India.

Inflammatory bowel disease (IBD), once considered a disease of the Western hemisphere, has emerged as a global disease. As the disease prevalence is on a steady rise, management of IBD has come under the spotlight. 5-Aminosalicylates, corticosteroids, immunosuppressive agents and biologics are the backbone of treatment of IBD. With the advent of biologics and small molecules, the need for surgery and hospitalization has decreased. However, economic viability and acceptability is an important determinant of local prescription patterns. Nearly one-third of the patients in West receive biologics as the first/initial therapy. The scenario is different in developing countries where biologics are used only in a small proportion of patients with IBD. Increased risk of reactivation of tuberculosis and high cost of the therapy are limitations to their use. Thiopurines hence become critical for optimal management of patients with IBD in these regions. However, approximately one-third of patients are intolerant or develop adverse effects with their use. This has led to suboptimal use of thiopurines in clinical practice. This review article discusses the clinical aspects of thiopurine use in patients with IBD with the aim of optimizing their use to full therapeutic potential.
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http://dx.doi.org/10.5217/ir.2020.00155DOI Listing
April 2021

Acute-on-Chronic Pancreatitis: Analysis of Clinical Profile and Outcome.

Cureus 2021 Apr 1;13(4):e14242. Epub 2021 Apr 1.

Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, IND.

Objective: Overall, a handful of studies are available on the outcomes of acute-on-chronic pancreatitis (ACP). We aimed to provide a more complete and updated picture of ACP.

Methods: We evaluated consecutive patients of acute exacerbation of chronic pancreatitis (CP) in a tertiary care center located in north India and studied their epidemiological profiles, etiological factors as well as outcomes.

Results: Forty-five patients of ACP with a mean age of 37±13 years were evaluated. The majority of the patients were male (75%) and alcohol was the most common detectable etiology while no etiology could be identified in 35% of patients after extensive laboratory investigations and imaging. Moderately severe pancreatitis was noted in 73% of patients and 49% of patients had necrotizing pancreatitis out of which the majority (33%) had both pancreatic as well as extra-pancreatic necrosis (EPN). Five patients (11%) were subjected to percutaneous catheter drainage. Persistent organ failure was noted in 9% of patients and two (4.5%) patients had died from organ failure.

Conclusion: To conclude, this study has demonstrated that ACP has a milder disease course and low morbidity and mortality. Early elimination of the etiological factor is essential for optimal outcome.
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http://dx.doi.org/10.7759/cureus.14242DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8017491PMC
April 2021

Multidimensional dynamic healthcare personnel (HCP)-centric model from a low-income and middle-income country to support and protect COVID-19 warriors: a large prospective cohort study.

BMJ Open 2021 02 22;11(2):e043837. Epub 2021 Feb 22.

Department of Hospital Administration, PGIMER, Chandigarh, India.

Objectives: Healthcare personnel (HCP) are at an increased risk of acquiring COVID-19 infection especially in resource-restricted healthcare settings, and return to homes unfit for self-isolation, making them apprehensive about COVID-19 duty and transmission risk to their families. We aimed at implementing a novel multidimensional HCP-centric evidence-based, dynamic policy with the objectives to reduce risk of HCP infection, ensure welfare and safety of the HCP and to improve willingness to accept and return to duty.

Setting: Our tertiary care university hospital, with 12 600 HCP, was divided into high-risk, medium-risk and low-risk zones. In the high-risk and medium-risk zones, we organised training, logistic support, postduty HCP welfare and collected feedback, and sent them home after they tested negative for COVID-19. We supervised use of appropriate personal protective equipment (PPE) and kept communication paperless.

Participants: We recruited willing low-risk HCP, aged <50 years, with no comorbidities to work in COVID-19 zones. Social distancing, hand hygiene and universal masking were advocated in the low-risk zone.

Results: Between 31 March and 20 July 2020, we clinically screened 5553 outpatients, of whom 3012 (54.2%) were COVID-19 suspects managed in the medium-risk zone. Among them, 346 (11.4%) tested COVID-19 positive (57.2% male) and were managed in the high-risk zone with 19 (5.4%) deaths. One (0.08%) of the 1224 HCP in high-risk zone, 6 (0.62%) of 960 HCP in medium-risk zone and 23 (0.18%) of the 12 600 HCP in the low-risk zone tested positive at the end of shift. All the 30 COVID-19-positive HCP have since recovered. This HCP-centric policy resulted in low transmission rates (<1%), ensured satisfaction with training (92%), PPE (90.8%), medical and psychosocial support (79%) and improved acceptance of COVID-19 duty with 54.7% volunteering for re-deployment.

Conclusion: A multidimensional HCP-centric policy was effective in ensuring safety, satisfaction and welfare of HCP in a resource-poor setting and resulted in a willing workforce to fight the pandemic.
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http://dx.doi.org/10.1136/bmjopen-2020-043837DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7902325PMC
February 2021

Primary EUS-guided therapy of a giant visceral artery pseudoaneurysm: Expanding horizons (with video).

Endosc Ultrasound 2021 Feb 10. Epub 2021 Feb 10.

Department of Gastroenterology, Post-Graduate Institute of Medical Education and Research, Chandigarh, India.

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http://dx.doi.org/10.4103/EUS-D-20-00210DOI Listing
February 2021

Quality of life in patients of corrosive esophageal stricture treated with endoscopic dilatation.

JGH Open 2021 Feb 12;5(2):301-306. Epub 2021 Jan 12.

Department of Psychiatry Postgraduate Institute of Medical Education and Research Chandigarh India.

Background And Aim: Caustic ingestion is associated with long-term sequelae in the form of esophageal and/or gastric cicatrization requiring endoscopic or surgical intervention. Quality of life (QoL) and disability in patients with caustic-induced sequelae is less explored.

Methods: In this prospective study, we included consecutive patients with symptomatic caustic-induced esophageal stricture undergoing endoscopic dilatation. QoL was measured using the World Health Organization Quality of Life questionnaire (WHOQoL-BREF). Disability was measured using the World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0). Subjective dysphagia score was calculated by Likert scale.

Results: A total of 42 patients were included in the study; 25 (59.5%) patients were male. Patients had poor WHOQoL-BREF and WHODAS scores compared to normality data in all domains of the scores among both the genders. A majority (66.7%) of patients had a current psychiatric diagnosis, with the most common being mood disorder (50%) followed by suicidality (45.2%). Males had a higher prevalence of a previous psychiatric diagnosis compared to females, while females had a higher prevalence of suicidality. Dysphagia score had strong correlation with the WHOQoL ( = -0.66;  < 0.01) and WHODAS ( = 0.71;  < 0.01).

Conclusion: Patients with esophageal stricture due to caustic ingestion on long-term endoscopic dilatation have poor QoL, high prevalence of psychological morbidity, and disability.
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http://dx.doi.org/10.1002/jgh3.12490DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7857296PMC
February 2021

Per Oral Endoscopic Myotomy for the Management of Large Esophageal Diverticula (D-POEM): Safe and Effective Modality for Complete Septotomy.

Dysphagia 2021 Feb 3. Epub 2021 Feb 3.

Department of Gastroenterology, Post Graduate Institute of Medical Education and Research, Sector 12, Chandigarh, 160012, India.

With the advent of the technique of sub-mucosal tunnelling, peroral endoscopic myotomy (POEM) has been used for the treatment of esophageal diverticulum, which otherwise is a recurring problem with conventional flexible endoscopic treatment due to incompleteness of septotomy. This study reports our experience of the use of diverticular POEM (D-POEM) technique in the management of large esophageal diverticulum. This is a retrospective study of prospectively maintained database including all consecutive patients with symptomatic esophageal diverticulum presenting at a tertiary care academic center. D-POEM was performed using the technique of submucosal tunnelling and septotomy. Besides baseline parameters, technical success, clinical success, size of diverticula, procedure time, complications and symptom recurrence on follow up were noted. A total of five patients (4 males; median age 72) were included with an average Charlson comorbidity index of 3.2 ± 0.8. Of them, three had Zenker's while two had epiphrenic diverticulum. The median symptom duration was 12 months with a mean diverticulum size of 68.8 ± 1.9 mm. The mean procedure time was 64.80 ± 12.6 min. with a mean septotomy/myotomy length of 79.44 ± 12.2 mm. Minor adverse events were noted intra-procedure in two cases. Clinical success achieved in all cases with a significant mean dysphagia score reduction from 2.20 to 0.20 post procedure (p = 0.011). On a median follow up of 280 days (range 98-330), none had recurrence of symptoms. Our data highlighted that complete septotomy by D-POEM technique can be achieved for the management of large esophageal diverticulum and is safe and effective.
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http://dx.doi.org/10.1007/s00455-021-10252-0DOI Listing
February 2021

Gastric secretion in patients with caustic ingestion: A prospective study.

Indian J Gastroenterol 2021 02 8;40(1):50-55. Epub 2021 Jan 8.

Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh 160 012, India.

Background: Caustic ingestion can lead to structural changes in the upper gastrointestinal tract. However, there are limited data on the effect of caustic ingestion on gastric secretion. This study was planned to determine the changes in gastric acid output in patients with caustic ingestion.

Methods: It was a prospective study done at a tertiary care center in northern India. Twenty consecutive patients in chronic phase of caustic ingestion were evaluated for the study. The gastric secretory function was estimated in the basal state and following pentagastrin stimulation. These results were compared with normal values for our laboratory.

Results: The mean age of the included patients (n = 20) was 27.35 ± 2.96 years and 14 patients were male. Sixteen (80%) patients had a history of acid ingestion. Patients with caustic ingestion had significantly lower mean gastric acid secretion (0.8 ± 0.4 mEq/h vs. 4 ± 0.4 mEq/h; p < 0.001) compared to controls. After pentagastrin stimulation, the mean gastric juice volume (31.8 ± 6 mL/h vs. 62.3 ± 11.7 mL/h; p < 0.01) and acidity (15.3 ± 5.1 mEq/L vs. 39.6 ± 9.3 mEq/L; p < 0.001) increased in patients with caustic ingestion, but were lower than those in control subjects. Patients with a lower esophageal stricture (n = 6) had decreased maximum acid output (0.62 ± 0.32 mEq/h vs. 6.05 ± 0.55 mEq/h; p < 0.05) compared to patients with stricture in the upper or middle esophagus.

Conclusion: Caustic ingestion is associated with reduced gastric juice volume and acid output. Patients with stricture in the lower one third of the esophagus are at a higher risk of hypochlorhydria compared to patients with stricture in either the upper or middle esophagus.
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http://dx.doi.org/10.1007/s12664-020-01116-wDOI Listing
February 2021

Splenic abscess in a tertiary care centre in India: clinical characteristics and prognostic factors.

ANZ J Surg 2020 Dec 28. Epub 2020 Dec 28.

Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.

Background: Splenic abscess has been an uncommon entity which is now being encountered more frequently due to increased prevalence of immunodeficiency disorders and chronic illnesses. This study was aimed to audit our experience with splenic abscesses at a tertiary care centre in India highlighting usefulness of an algorithmic approach.

Methods: Retrospective analysis of data of patients (January 2014 to December 2019) with splenic abscess was done. Data were retrieved for clinical characteristics, radiological findings, organism spectra, abscess characteristics, therapeutic measures and clinical outcome.

Results: The mean age of the study population (n = 36) was 41.3 ± 19.0 years with 50% males. Comorbidities were identified in 17 (47.2%) patients, with diabetes mellitus being the commonest. Fever and abdominal pain were the most common presenting features. Multiple splenic abscesses were present in 21 (58.3%) patients. Extra-splenic abscesses in liver were seen in five (13.9%) patients while nine (25%) patients had ruptured splenic abscess. Microorganisms were identified in 24 (66.7%) patients, with Salmonella typhi being the commonest (n = 9, 25%) followed by Escherichia coli (n = 7, 19.4%) and Staphylococcus aureus (n = 4, 11.1%). Six patients received only antimicrobials, 24 were managed with percutaneous aspiration or catheter drainage and six required surgery. Five (13.9%) patients died, with highest mortality being seen in those who received only antimicrobial (50%), compared to percutaneous aspiration or catheter drainage (8.3%) and surgery (0%), P = 0.017.

Conclusion: Using percutaneous aspiration or drainage in conjunction with antibiotics, followed by surgery in non-responder, patients with splenic abscesses can be managed successfully with acceptable mortality.
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http://dx.doi.org/10.1111/ans.16517DOI Listing
December 2020

Early intra-abdominal hypertension: A reliable bedside prognostic marker for severe acute pancreatitis.

JGH Open 2020 Dec 4;4(6):1091-1095. Epub 2020 Aug 4.

Department of General Surgery Postgraduate Institute of Medical Education and Research Chandigarh India.

Background And Aim: Severe acute pancreatitis (SAP) is commonly associated with intra-abdominal hypertension (IAH). This acute increase of intra-abdominal pressure (IAP) may be attributed to early organ dysfunction, leading to an increased morbidity and mortality. To assess the incidence of raised IAH and its correlation with other prognostic indicators and various outcomes in SAP.

Methods And Results: This was a prospective observational study in patients of SAP between July 2009 and December 2010. All patients of SAP who were admitted to the hospital within 2 weeks of onset of pain were included in the study. A total of 35 patients with SAP were included in the study. Among these, 25 (71.4%) were males. All our patients had raised IAP; however, IAH was present in 51.4% (18/35). Patients with IAH were found to have a higher APACHE II score (88.9 5.9%;  < 0.001), infectious complications (72.2 5.9%;  < 0.001), circulatory failure (88.9 0%;  < 0.001), and respiratory failure (100 41.2%;  < 0.001). All the eight (22.8%) patients who succumbed to sepsis had IAH. Patients with IAH were found to have a significantly longer intensive care unit (ICU) stay (17.72 12.29 days) and in-hospital stay (24.89 12.29 days).

Conclusion: IAH is a good negative prognostic marker in SAP, seen in up to 51.4%. IAH was found to have a significant negative impact on the outcome in terms of increased mortality, morbidity, in-hospital stay, and ICU stay among the patients of SAP.
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http://dx.doi.org/10.1002/jgh3.12393DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7731827PMC
December 2020

Efficacy of endovascular embolization of arterial pseudoaneurysms in pancreatitis: A systematic review and meta-analysis.

Pancreatology 2021 Jan 2;21(1):46-58. Epub 2020 Dec 2.

Department of Gastroenterology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012, India.

Background: There is a significant variability in the reported outcomes following endovascular embolization of arterial pseudoaneurysms in pancreatitis. The objective of this systematic review and meta-analysis is to evaluate the efficacy of endovascular embolization of pancreatitis-related pseudoaneurysms.

Methods: Searches of MEDLINE, EMBASE, and SCOPUS databases were performed through July 1, 2019 in accordance with PRISMA guidelines. All studies with ≥10 patients reporting technical success, clinical success, complications, and mortality were included. Generalized linear mixed method with random effects model was used for assessing pooled incidence rates and corresponding 95% confidence intervals (CIs).

Results: A total of 29 studies (n = 840 with 638 pseudoaneurysms) were included. The pooled incidence rates of pseudoaneurysms in acute and chronic pancreatitis were 0.05% and 0.03%, respectively (odds ratio, 0.91, 95% CI-0.24-3.43). The most common site of pseudoaneurysm was splenic artery (37.7%). The most common embolization agent was coil (n = 415). The follow up period was 54.7 months (range, 21 days to 40.5 months). Pooled technical success rate was 97% (95% CI-92-99%, I 83%). Clinical success rates at ≤3 months, 3-12 months, and >12 months were 82% (95% CI-70-90%, I 42%), 86% (95% CI-75-92%, I 44%), and 88% (95% CI-83-91%, I 0%), respectively. There was no significant difference in the technical or clinical success between acute and chronic pancreatitis on subgroup analysis. Mortality was lower in chronic pancreatitis (OR 4.27 (95% CI 1.35-13.53, I 0%)). Splenic infarction was the most common complication (n = 47).

Conclusion: Endovascular embolization is associated with a high technical and clinical success.
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http://dx.doi.org/10.1016/j.pan.2020.11.017DOI Listing
January 2021

Coronavirus disease 2019 and the pancreas.

Pancreatology 2020 Dec 12;20(8):1567-1575. Epub 2020 Oct 12.

Department of Gastroenterology, PGIMER, Chandigarh, India. Electronic address:

Coronavirus disease 2019 (COVID-19) caused by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) has led to a world-wide pandemic since its onset in December of 2019. Although, a primary respiratory pathogen, over the ensuing period, its extra-pulmonary effects have come to the forefront. The virus, having multi-organ tropism, has been shown to affect a host of other organs beyond the lung, including the pancreas. The data on pancreatic involvement by COVID-19, however, have been limited. Moreover, whether the effects on the pancreas are due to the direct effects of the virus or is just an epi-phenomenon is debatable. The prevalence of pancreatic injury and degree of injury are the other issues that need to be addressed. Pancreatic cancer has a dismal prognosis and the management of the same in the COVID era needs to be tailored assessing the risk-benefit ratio for the same. Additionally, pancreatic surgery increases not only the morbidity of the patient, but also the risk of the operator and burden on the health care system. Hence, the decision for such major procedures needs to be rationalized for optimum benefit during this pandemic. Similarly, for the endoscopist, pancreatic endoscopy needs to be carefully regulated to reduce risk to both the patient and the physician and yet deliver optimum patient care. This review gives a concise summary of various aspects of pancreatic involvement and pancreatic disease management during this pandemic.
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http://dx.doi.org/10.1016/j.pan.2020.10.035DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7550073PMC
December 2020

Outcome of percutaneous drainage in patients with pancreatic necrosis having organ failure.

HPB (Oxford) 2021 Jul 21;23(7):1030-1038. Epub 2020 Nov 21.

Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India. Electronic address:

Background: Percutaneous catheter drainage (PCD) is an effective way of drainage in acute pancreatitis (AP) and its role in persistent organ failure (OF) has not been studied. This study assessed the outcome of severe AP managed with PCD.

Methods: We retrospectively analysed outcome of AP patients undergoing PCD for persistent OF with respect to success of PCD, etiology, severity scores, OF, imaging features and PCD parameters. Success of PCD was defined as resolution of with PCD and survived without surgical necrosectomy.

Results: Between January 2016 and May 2018, 83 patients underwent PCD for persistent OF at a mean duration of 25.59 ± 21.2 days from pain onset with successful outcome in 47 (56.6%) patients. Among PCD failures, eleven (13.25%) patients underwent surgery. Overall mortality was 31 (37.3%). On multivariate analysis, pancreatic necrosis <50% and absence of extrapancreatic infection (EPI) predicted the success of PCD. Presence of infected necrosis did not affect the outcome of PCD in organ failure.

Conclusion: PCD improves the outcome in patients with OF even when done early irrespective of the status of infection of necrosis. Therefore, PCD may be considered early in the course of patients with OF.
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http://dx.doi.org/10.1016/j.hpb.2020.10.021DOI Listing
July 2021

Larger bore percutaneous catheter in necrotic pancreatic fluid collection is associated with better outcomes.

Eur Radiol 2021 May 5;31(5):3439-3446. Epub 2020 Nov 5.

Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012, India.

Objective: To evaluate the impact of initial catheter size on the clinical outcomes in acute pancreatitis (AP).

Methods: This retrospective study comprised consecutive patients with AP who underwent percutaneous catheter drainage (PCD) between January 2018 and May 2019. Three hundred fifteen consecutive patients underwent PCD during the study period. Based on the initial catheter size, patients were divided into group I (≤ 12 F) and group II (> 12 F). The differences in the clinical outcomes between the two groups, as well as multiple subgroups (based on the severity, timing of drainage, and presence of organ failure (OF)), were evaluated.

Results: One hundred forty-six patients (mean age, 41.2 years, 114 males) fulfilled the inclusion criteria. Ninety-nine (67.8%) patients had severe AP based on revised Atlanta classification. The mean pain to PCD was 22 days (range, 3-267 days). Mean length of hospitalization (LOH) was 27.9 ± 15.8 days. Necrosectomy was performed in 20.5% of patients, and mortality was 16.4%. Group I and II comprised 74 and 72 patients, respectively. There was no significant difference in baseline characteristics, except for a greater number of patients with OF in group II (p = 0.048). The intensive care unit stay was significantly shorter, and multiple readmissions were less frequent in group II (p = 0.037 and 0.013, respectively). Patients with severe AP and moderately severe AP in group II had significantly reduced rates of readmissions (p = 0.035) and significantly shorter LOH (p = 0.041), respectively.

Conclusion: Large-sized catheters were associated with better clinical outcomes regardless of disease severity and other baseline disease characteristics.

Key Points: • Larger catheter size for initial PCD was associated with better clinical outcomes in AP. • The benefits were independent of the severity of AP, timing of PCD (ANC vs. WON) and presence of organ failure.
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http://dx.doi.org/10.1007/s00330-020-07411-6DOI Listing
May 2021

Comparison of virtual computed tomography enteroscopy using carbon dioxide with small-bowel enteroclysis and capsule endoscopy in patients with small-bowel tuberculosis.

Eur Radiol 2021 May 4;31(5):3297-3305. Epub 2020 Nov 4.

Department of Radiology, Wake Forest University School of Medicine, NC, 27101, Winston-Salem, USA.

Objective: Comparison of virtual CT enteroscopy (VCTE) using carbon dioxide with small-bowel enteroclysis (SBE) and capsule endoscopy (CE) in small-bowel tuberculosis (SBTB).

Methods: This prospective study comprised consecutive patients suspected to have SBTB. VCTE and SBE were performed on the same day and evaluated by independent radiologists. CE was performed within 2 weeks. VCTE was performed following insufflation of carbon dioxide via catheters in the jejunum and anorectum. A contrast-enhanced CT was followed by a delayed non-contrast CT. Image processing was done using virtual colonoscopy software. Findings on VCTE, SBE, and CE were compared. The final diagnosis of SBTB was based on either histopathological or cytological findings, response to antitubercular treatment, or a combination of these.

Results: Of the 55 patients in whom VCTE was performed, complete data was available in 52 patients. A final diagnosis of SBTB was established in 37 patients. All patients had VCTE and SBE. CE was performed in 34 patients. Adequate luminal distension was achieved in all patients with SBE and 35 patients with VCTE. SBE showed more strictures in jejunum (10.8%) and ileum (75.7%) compared with VCTE (jejunum, 8.1%, and ileum, 64.9%) and CE (jejunum, 5.9%, and ileum, 61.8%). However, difference was not statistically significant. VCTE revealed a greater length of strictures in both the jejunum and ileum compared with SBE and CE.

Conclusion: VCTE allows adequate evaluation of the bowel in most patients with SBTB. It allows detection of greater length of abnormality in jejunum and ileum compared with SBE and CE.

Key Points: • The use of VCTE using CO bowel insufflation in patients with SBTB should be considered. • VCTE allows detection of a greater length of abnormality in the jejunum and ileum.
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http://dx.doi.org/10.1007/s00330-020-07410-7DOI Listing
May 2021

Low risk of transmission of SARS-CoV2 and effective endotherapy for gastrointestinal bleeding despite challenges supports resuming optimum endoscopic services.

Dig Liver Dis 2021 Jan 14;53(1):4-7. Epub 2020 Oct 14.

Department of Gastroenterology and Human Nutrition Unit, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, India. Electronic address:

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http://dx.doi.org/10.1016/j.dld.2020.10.009DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7556781PMC
January 2021

Introduction and Validation of a Novel Acute Pancreatitis Digital Tool: Interrogating Large Pooled Data From 2 Prospectively Ascertained Cohorts.

Pancreas 2020 Nov/Dec;49(10):1276-1282

Department of Internal Medicine, Division of Gastroenterology, Hepatology, and Nutrition, Ohio State University, Wexner Medical Center, Columbus, OH.

Objectives: Acute pancreatitis (AP) is a sudden onset, rapidly evolving inflammatory response with systemic inflammation and multiorgan failure (MOF) in a subset of patients. New highly accurate clinical decision support tools are needed to allow local doctors to provide expert care.

Methods: Ariel Dynamic Acute Pancreatitis Tracker (ADAPT) is a digital tool to guide physicians in ordering standard tests, evaluate test results and model progression using available data, propose emergent therapies. The accuracy of the severity score calculators was tested using 2 prospectively ascertained Acute Pancreatitis Patient Registry to Examine Novel Therapies in Clinical Experience cohorts (pilot University of Pittsburgh Medical Center, n = 163; international, n = 1544).

Results: The ADAPT and post hoc expert-calculated AP severity scores were 100% concordant in both pilot and international cohorts. High-risk criteria of all 4 severity scores at admission were associated with moderately-severe or severe AP and MOF (both P < 0.0001) and prediction of no MOF was 97.8% to 98.9%. The positive predictive value for MOF was 7.5% to 14.9%.

Conclusions: The ADAPT tool showed 100% accuracy with AP predictive metrics. Prospective evaluation of ADAPT features is needed to determine if additional data can accurately predict and mitigate severe AP and MOF.
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http://dx.doi.org/10.1097/MPA.0000000000001686DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8128442PMC
October 2020

Intraductal ultrasound in portal cavernoma cholangiopathy: The closer the better.

Indian J Gastroenterol 2020 Oct 24. Epub 2020 Oct 24.

Department of Gastroenterology, Post-Graduate Institute of Medical Education and Research, Chandigarh, 160 012, India.

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http://dx.doi.org/10.1007/s12664-020-01110-2DOI Listing
October 2020

Feasibility and safety of bedside percutaneous biliary drainage in patients with severe cholangitis.

Abdom Radiol (NY) 2021 05 23;46(5):2156-2160. Epub 2020 Oct 23.

Department of Radiodiagnosis and Imaging, PGIMER, Chandigarh, India.

Purpose: To evaluate the safety and feasibility of bedside percutaneous transhepatic biliary drainage (PTBD) as a salvage procedure in patients with severe cholangitis in the intensive care unit (ICU).

Methods: This retrospective study evaluated records of consecutive patients with severe cholangitis who were admitted in the ICU. Bedside PTBD was performed using ultrasound guidance. The level and cause of biliary obstruction were recorded. The technical success of the procedure and complications were recorded.

Results: Ten patients (six males, mean age 53.8 years) underwent bedside PTBD. Six patients had distal common bile duct blockade [periampullary carcinoma (n = 2), carcinoma pancreas (n = 2), choledocholithiasis (n = 1), and benign stricture (n = 1)]. Four patients had malignant hilar stricture [cholangiocarcinoma (n = 3) and carcinoma gallbladder (n = 1)]. Technical success was achieved in all. One patient underwent bilateral PTBD. Left and right PTBD were performed in 5 and 4 patients, respectively. There were no major complications. Transient hemobilia occurred in two patients.

Conclusion: Bedside PTBD is safe and technically feasible. Prospective studies are required to establish this procedure into routine clinical practice.
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http://dx.doi.org/10.1007/s00261-020-02825-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7583693PMC
May 2021

Can serum resistin predict severity of acute pancreatitis?

Biomarkers 2021 Feb 8;26(1):31-37. Epub 2020 Dec 8.

Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.

Objective: Acute pancreatitis (AP) is a common disorder with high mortality in severe cases. Several markers have been studied to predict development of severe AP (SAP) including serum resistin with conflicting results. This study aimed at assessing the role of baseline serum resistin levels in predicting SAP.

Methods: This prospective study collected data from 130 AP patients from July 2017 to Nov 2018. Parameters measured included demographic profile, serum resistin at admission, severity scores, hospital stay, surgery, and mortality. Patients were divided into two groups, severe and non-severe AP. The two groups were compared for baseline characteristics, serum resistin levels, hospital stay, surgery and mortality.

Results: Among 130 patients, 53 patients had SAP. SAP patients had higher BMI, baseline CRP, APACHE II and CTSI scores (-value 0.045, <0.001, <0.001 and 0.001, respectively). Both groups had comparable serum resistin levels. Serum resistin levels were also not different for obese and non-obese patients (-value = 0.62). On multivariate analysis, BMI and high APACHE II score and CRP levels were found to independently predict SAP.

Conclusion: We found that serum resistin is not a useful marker for predicting the severity of AP and does not correlate with increasing body weight.
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http://dx.doi.org/10.1080/1354750X.2020.1841295DOI Listing
February 2021

Can high-frequency mini-probe endoscopic ultrasonography predict outcome of endoscopic dilation in patients with benign esophageal strictures?

Endosc Int Open 2020 Oct 22;8(10):E1371-E1378. Epub 2020 Sep 22.

Department of Gastroenterology, Post Graduate Institute of Medical Education and Research, Chandigarh, India.

 Endoscopic dilation is first-line management for benign esophageal strictures (ES). Depth of involvement of the esophageal wall on endosonography using high frequency mini-probe (EUS-M) may predict response to dilation. This study evaluated EUS-M characteristics to predict response of ES to endoscopic dilation.  EUS-M was used to measure the total esophageal wall thickness (EWT), involved EWT, percentage of involved wall and layers of wall involved in consecutive patients of benign ES. After a maximum of five sessions of endoscopic dilation, the cohort was divided into responders and refractory strictures. EUS-M characteristics were compared for underlying etiology as also between responders and refractory strictures.  Of the 30 strictures (17 females, age: 47.16 ± 15.86 yrs.) 13 were anastomotic, eight corrosive, seven peptic and 2 others. Corrosive strictures had the highest involved EWT and percentage of involved wall (3.51 ± 1.36 mm; 76.38 %) followed by anastomotic (2.73 ± 1.7 mm; 65.54 %) and peptic (1.39 ± 0.62 mm; 40.71 %) (  = 0.026 and 0.021 respectively). After five dilations, 22 were classified as responders and eight as refractory. Wall involvement > 70 % had a greater proportion of refractory strictures (  = 0.019). Strictures with involved EWT of ≥ 2.85 mm required more dilations (  = 0.011). Fewer dilations were required for stricture resolution with only mucosal involvement compared to deeper involvement such as submucosa and (2.14 vs. 5.80;  = 0.001).  EUS-M evaluation shows that corrosive and anastomotic strictures have greater depth of involvement compared to peptic strictures. Depth of esophageal wall involvement in a stricture predicts response to dilation.
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http://dx.doi.org/10.1055/a-1223-1377DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7508664PMC
October 2020

Development and validation of a computed tomography index for assessing outcomes in patients with acute pancreatitis: "SMART-CT" index.

Abdom Radiol (NY) 2021 04 16;46(4):1618-1628. Epub 2020 Sep 16.

Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India.

Purpose: The existing CT indices do not allow quantitative prediction of clinical outcomes in acute pancreatitis (AP). The aim of this study was to develop and validate a revised CT index using a nomogram-based approach.

Methods: This retrospective study comprised consecutive patients with AP who underwent contrast-enhanced CT between June 2017 and March 2019. 123 CT scans were randomly divided into training (n = 103) and validation groups (n = 20). Two radiologists analyzed CT scans for findings described in modified CT severity index and additional exploratory items (13 items). Seven items (pancreatic necrosis, number of collections, size of collections, ascites, pleural effusion, celiac artery involvement, and liver steatosis) found to be statistically significant were used for development of index. Synthetic minority oversampling technique (SMOTE) was employed to balance representation of minority classes and hence this index was named "SMOTE Application for Reading CT in AcuTe Pancreatitis (SMART-CT index)". Binomial logistic regression was used for development of prediction algorithm. Nomograms were then created and validated for each outcome.

Results: The new CT index had area under the curve (AUC) of 0.79 [95% CI 0.65-0.93], 0.66 (95% CI 0.54-0.77), 0.75 (95% CI 0.65-0.85), 0.83 (95% CI 0.69-0.96), 0.70 (95% CI 0.60-0.81), and 0.64 (95% CI 0.53-0.75) for mortality, intensive care unit (ICU) stay, length of hospitalization, length of ICU stay, number of admissions, and severity, respectively. The AUC of validation cohort was comparable to the training cohort.

Conclusion: The novel nomogram-based index predicts occurrence of clinical outcome with moderate accuracy.
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http://dx.doi.org/10.1007/s00261-020-02740-yDOI Listing
April 2021

Incidence and risk factors of oral feeding intolerance in acute pancreatitis: Results from an international, multicenter, prospective cohort study.

United European Gastroenterol J 2021 Feb 12;9(1):54-62. Epub 2021 Feb 12.

Department of Gastroenterology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.

Background: Inability to advance to an oral diet, or oral feeding intolerance, is a common complication in patients with acute pancreatitis associated with worse clinical outcomes. The factors related to oral feeding intolerance are not well studied.

Objective: We aimed to determine the incidence and risk factors of oral feeding intolerance in acute pancreatitis.

Methods: Patients were prospectively enrolled in the Acute Pancreatitis Patient Registry to Examine Novel Therapies in Clinical Experience, an international acute pancreatitis registry, between 2015 and 2018. Oral feeding intolerance was defined as worsening abdominal pain and/or vomiting after resumption of oral diet. The timing of the initial feeding attempt was stratified based on the day of hospitalization. Multivariable logistic regression was performed to assess for independent risk factors/predictors of oral feeding intolerance.

Results: Of 1233 acute pancreatitis patients included in the study, 160 (13%) experienced oral feeding intolerance. The incidence of oral feeding intolerance was similar irrespective of the timing of the initial feeding attempt relative to hospital admission day (p = 0.41). Patients with oral feeding intolerance were more likely to be younger (45 vs. 50 years of age), men (61% vs. 49%), and active alcohol users (44% vs. 36%). They also had higher blood urea nitrogen (20 vs. 15 mg/dl; p < 0.001) and hematocrit levels (41.7% vs. 40.5%; p = 0.017) on admission; were more likely to have a nonbiliary acute pancreatitis etiology (69% vs. 51%), systemic inflammatory response syndrome of 2 or greater on admission (49% vs. 35%) and at 48 h (50% vs. 26%), develop pancreatic necrosis (29% vs. 13%), moderate to severe acute pancreatitis (41% vs. 24%), and have a longer hospital stay (10 vs. 6 days; all p < 0.04). The adjusted analysis showed that systemic inflammatory response syndrome of 2 or greater at 48 h (odds ratio 3.10; 95% confidence interval 1.83-5.25) and a nonbiliary acute pancreatitis etiology (odds ratio 1.65; 95% confidence interval 1.01-2.69) were independent risk factors for oral feeding intolerance.

Conclusion: Oral feeding intolerance occurs in 13% of acute pancreatitis patients and is independently associated with systemic inflammatory response syndrome at 48 h and a nonbiliary etiology.
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http://dx.doi.org/10.1177/2050640620957243DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8259260PMC
February 2021
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