Publications by authors named "S Meenakshi Sundaram"

727 Publications

Systematic review with meta-analysis: the long-term efficacy of Barrett's endoscopic therapy-stringent selection criteria and a proposal for definitions.

Aliment Pharmacol Ther 2021 Jun 24. Epub 2021 Jun 24.

Department of Gastroenterology, Kansas City VA Medical Center, Kansas City, MO, USA.

Background: Barrett's endoscopic therapy (BET) is well established for neoplasia in Barrett's oesophagus using a concept of complete eradication of all Barrett's. However, long-term efficacy is not known.

Aims: To perform a systematic review and meta-analysis to examine long-term efficacy of BET for Barrett's neoplasia.

Methods: Electronic databases were searched for studies meeting stringent criteria: (a) subjects with high-grade dysplasia and/or superficial adenocarcinoma who underwent BET (ablation ± endoscopic mucosal resection); (b) BET completion by confirmation of complete eradication of neoplasia (CE-N) and intestinal metaplasia (CE-IM) with systematic sampling and (c) clearly defined follow-up (endoscopy and biopsy) protocol of ≥2 years thereafter for detection of recurrence. Pooled estimates of CE-N and CE-IM after BET completion and follow-up were analysed.

Results: Eight studies met the stringent criteria (n = 794, males 89%, age 64.6 years). Despite high efficacy of BET at therapy completion (CE-N: 95.9 [91.7-98.7]%; CE-IM: 90.9 [83-96.6]%), this declined (CE-N: 89 [73.4-98.2]%; CE-IM: 77.8 [65.6-88]%) over 3.4 years of follow-up. There was considerable heterogeneity. Only two studies reported a post-BET follow-up of >5 years (CE-IM 50 [41.5%-58.5]%). Higher person years of follow-up seem to correlate with decrease in BET efficacy.

Conclusion: Using stringent criteria for appropriate study selection with sufficient follow-up, a lack of high-quality controlled intervention trials becomes evident for assessment of long-term durable remission rates of BET despite initial high success rates. We plea for a uniform documentation of study details which could be used in future trials.
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http://dx.doi.org/10.1111/apt.16473DOI Listing
June 2021

Intermediate-term neurodevelopmental outcomes and quality of life after arterial switch operation beyond early neonatal period.

Eur J Cardiothorac Surg 2021 Jun 21. Epub 2021 Jun 21.

Department of Cardiovascular and Thoracic Surgery, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India.

Objectives: The study objective was to evaluate the cardiac, neurodevelopmental, psycho-social and health-related quality of life (HRQOL) outcomes of children who underwent an arterial switch operation (ASO).

Methods: Children who underwent ASO were evaluated on follow-up at 3-5 years with cardiovascular, neurodevelopmental and HRQOL assessment using validated tools. Children with developmental delay, attention-deficit hyperactivity disorder, autism spectrum disorder, neuromotor and speech and language impairment were considered to have neurodevelopmental disorder (NDD). The impact of socioeconomic status (Kuppuswamy classification), perioperative cardiac, nutritional and psycho-social factors on outcomes was analysed.

Results: There were 61 (89.7%) survivors at a mean follow-up of 50.9 ± 7.6 months. The median age at surgery was 41 days (22-74.5). One-third of patients had growth restriction. Two children had residual cardiovascular lesions requiring intervention. The mean HRQOL score was >90 in all scales of the Paediatric Quality of Life Inventory™ 3.0 Cardiac Module. Neurological abnormalities were seen in 19 patients (31.1%) of whom 17 (27.9%) patients had NDD and 12 had developmental delay. Speech and language impairment, attention-deficit hyperactivity disorder, and neuromotor impairment were found in 16.4%, 3.3% and 6.7% patients, respectively. On multivariate analysis, increasing time to lactate normalization and low socioeconomic status were associated with developmental delay after ASO.

Conclusions: While intermediate-term cardiac outcomes and HRQOL after ASO were fairly satisfactory, NDD was identified in one-fourth of these children. Increasing time to lactate normalization after ASO and low socioeconomic status were associated with suboptimal intermediate neurodevelopment outcomes after ASO.
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http://dx.doi.org/10.1093/ejcts/ezab223DOI Listing
June 2021

EUS-guided biliary drainage for malignant hilar biliary obstruction: A concise review.

Endosc Ultrasound 2021 May-Jun;10(3):154-160

Institute of Digestive and Liver Care, SL Raheja Hospital, Mumbai, Maharashtra, India.

EUS-guided biliary drainage (EUS-BD) has emerged as an alternative to ERCP for distal biliary obstruction in expert hands. Various routes for EUS-guided access in distal biliary obstruction include EUS choledochoduodenostomy, EUS-guided rendezvous, and EUS-antegrade (EUS-AG) stent placement. While percutaneous transhepatic biliary drainage and ERCP are established modalities in management of malignant hilar biliary obstruction, the role of EUS-BD is emerging. Various methods of drainage in hilar obstruction include EUS hepaticogastrostomy, EUS hepaticoduodenostomy, EUS-guided bridging stent placement, and combined ERCP and EUS-guided biliary drainage. In this review, we discuss the role of EUS-BD in malignant hilar biliary obstruction with the currently available evidence, along with the limitations and challenges to the use of this modality in management of these patients.
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http://dx.doi.org/10.4103/EUS-D-21-00004DOI Listing
June 2021

Challenging the Traditional Paradigm of Supply and Demand in Pediatric Liver Transplantation Through Non-Directed Living Donation: A Case Series.

Liver Transpl 2021 May 28. Epub 2021 May 28.

Division of Transplantation, Department of Surgery, University of Colorado School of Medicine, Aurora, CO, USA.

Background: A gap exists between the demand for pediatric liver transplantation and the supply of appropriate size-matched donors. We describe our center's experience with pediatric liver transplantation using anonymous non-directed living liver donors (ND-LLD).

Methods: First-time pediatric liver transplant candidates listed at our center between January 2012 and June 2020 were retrospectively reviewed, categorized by donor graft type, and recipients of ND-LLD grafts were described.

Results: 13 ND-LLD pediatric liver transplants were performed, including 8 left lateral segments, 4 left lobes, and 1 right lobe. 5 of the ND-LLD recipients had no directed living donor evaluated, while the remaining 8 (62%) had all potential directed donors ruled out during the evaluation process. Recipient and graft survival was 100% over a median follow up time of 445 (70 - 986) days. 69% of ND-LLD were previous living kidney donors and one ND-LLD went on to donate a kidney after liver donation. 46% of the ND-LLD were approved prior to the recipient being listed. Over time, the proportion of living donor transplants performed, specifically from ND-LLD, increased and the number of children on the waitlist decreased.

Conclusion: The introduction of ND-LLDs to a pediatric liver transplant program can expand the benefit of living donor liver transplantation to children without a suitable directed living donor, while achieving excellent outcomes for both the recipients and donors.
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http://dx.doi.org/10.1002/lt.26108DOI Listing
May 2021

The Inescapable Conundrum of Klippel-Feil Syndrome Airway: Case Reports.

AANA J 2021 Jun;89(3):195-199

is a senior resident, Department of Anesthesiology, Pain Medicine and Critical Care, All India Institute of Medical Sciences.

Klippel-Feil syndrome (KFS) is a rare congenital anomaly that is characterized by short neck, low posterior hairline, and restricted neck movements, all of which lead to the possibility of a difficult airway. These patients often have associated multiple systemic anomalies, which add to the challenges in anesthetic management. We describe the anesthetic management of 3 patients with KFS: 2 who underwent modified radical mastoidectomy and 1 patient who underwent vaginoplasty at our institute. Careful planning and preparedness for difficult airway and thorough knowledge of associated comorbidities are key to successful management of patients with KFS.
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June 2021