Publications by authors named "Surinder S Rana"

140 Publications

Contrast-enhanced endoscopic ultrasound features of tubercular lymphadenopathy.

Trop Doct 2021 Jul 4:494755211028057. Epub 2021 Jul 4.

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

There is lack of data on the contrast-enhanced endoscopic ultrasound features of tubercular lymph node; our retrospective analysis of 37 patients with enlarged mediastinal and abdominal lymph nodes showed heterogeneous enhancement in the great majority (70%).
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1177/00494755211028057DOI Listing
July 2021

A Novel Cohesinopathy Causing Chronic Intestinal Pseudo Obstruction in 2 Siblings and Literature Review.

J Neurogastroenterol Motil 2021 07;27(3):436-437

Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Post Graduate Institute of Medical Education and Research, Chandigarh, India.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.5056/jnm20259DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8266498PMC
July 2021

Conservative or surgical treatment for groove pancreatitis: can endoscopic ultrasound guide the management strategy?

HPB (Oxford) 2021 Jun 17. Epub 2021 Jun 17.

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

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.hpb.2021.06.001DOI Listing
June 2021

Computed tomography features predictive of intra-abdominal hypertension in acute necrotizing pancreatitis:  A prospective study.

Indian J Gastroenterol 2021 Jun 21;40(3):326-332. Epub 2021 May 21.

Department of Surgical Gastroenterology, Post Graduate Institute of Medical Education and Research , Sector 12, Chandigarh, 160 012, India.

Background: Intra-abdominal hypertension (IAH) and abdominal compartment syndrome (ACS) in acute pancreatitis (AP) are associated with development and worsening of organ failures and poor prognosis. Limited studies suggest that contrast-enhanced computed tomography (CECT) can predict the presence of IAH/ACS. We aimed to study clinical profile of patients with AP and IAH and identify predictive factors of IAH on CECT abdomen.

Methods: Consecutive patients admitted with moderately severe and severe acute pancreatitis (SAP) were recruited. Clinical and radiological data were recorded prospectively. Intra-abdominal pressure was measured via a urinary catheter to document the presence of IAH/ACS. CECT abdomen was done within the first week of admission and various features that may predict the presence of IAH were studied.

Results: Thirty-seven patients (24 SAP) (mean age: 39.78 ± 13.43 years and 67.6% males) with  AP were studied. The most common etiology was alcohol (37.7%). IAH developed in 54.05% of patients; patients with IAH had significantly higher bedside index of severity in AP (BISAP), Acute Physiologic Assessment and Chronic Health Evaluation II (APACHE II) score, persistent acute lung injury (ALI), persistent acute kidney injury (AKI), persistent cardiovascular failure (CVSF), intensive care unit (ICU) stay, and mortality. Among the CT predictors, patients with IAH more commonly had moderate-gross ascites (60% vs. 23.5%, p-value - 0.026), a pancreatic necrosis of > 50% (50% vs. 17.6%, p-value - 0.04), and a round belly sign (RBS) (50% vs. 5.9%, p-value 0.03). On multivariate analysis, only RBS was predictive of  IAH (odds ratio 12.6, 95% confidence interval 1.3-124.2, p-value 0.03). The sensitivity, specificity, positive predictive value, and negative predictive value for RBS were 50%, 94.12%, 90.9%, and 61.54%, respectively.

Conclusion: Presence of RBS, moderate-gross ascites, and pancreatic necrosis of > 50% on CECT can predict the presence of IAH in these groups of patients.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s12664-021-01149-9DOI Listing
June 2021

Strongyloides Stercoralis in Acute Severe Ulcerative Colitis-A Triggering Nuisance or An Opportunistic Bystander?

Inflamm Bowel Dis 2021 May 21. Epub 2021 May 21.

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

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1093/ibd/izab119DOI Listing
May 2021

Endoscopic ultrasound-guided gallbladder drainage: a technical review.

Authors:
Surinder S Rana

Ann Gastroenterol 2021 4;34(2):142-148. Epub 2021 Jan 4.

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

Endoscopic ultrasound-guided gallbladder drainage (EUS-GBD) has emerged as a safe and effective minimally invasive alternative to both percutaneous and endoscopic transpapillary GBD in patients with acute cholecystitis. Over the last few years, the technique, as well as the indications for EUS-GBD have been gradually evolving, and the procedure has become simpler and safer as the accepted indications have expanded. The development of lumen-apposing metal stents (LAMS) has allowed us to realize the dream of creating endoscopic gastrointestinal anastomoses, and has thus paved the way for a safer EUS-GBD. Single step EUS-guided LAMS delivery systems have obviated the use of other endoscopic accessories and thus made EUS-GBD simpler and safer. However, EUS-GBD can be associated with potentially serious complications, and therefore should be performed by expert interventional endosonologists at centers with surgical and radiological back up. EUS-GBD is a relatively new procedure still in its infancy, but continued improvement in EUS accessories and dedicated stents will make this procedure safer and also expand its current indications. This review focuses on the technical aspects, including procedural details, as well as the complications of EUS-GBD.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.20524/aog.2020.0568DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7903569PMC
January 2021

Transrectal endoscopic ultrasound in undiagnosed ascites: is it a peritoneal deposit?

Endoscopy 2021 Feb 19. Epub 2021 Feb 19.

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

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1055/a-1353-4637DOI Listing
February 2021

Early transluminal drainage of pancreatic necrotic collections.

Gastrointest Endosc 2020 11;92(5):1136

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

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.gie.2020.05.038DOI Listing
November 2020

Retino-choroidal changes in patients with acute pancreatitis: A prospective analysis of a novel biomarker.

Pancreatology 2020 Dec 11;20(8):1604-1610. Epub 2020 Oct 11.

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

Background: There is paucity of data on ocular changes in acute Pancreatitis (AP). Moreover, subclinical alterations in retina & choroid have not been studied in AP.

Objective: To prospectively study retino-choroidal changes in AP.

Methods: Sixty patients (mean age 39.07 years; 41 males) with AP were followed up till recovery/death. Baseline slit-lamp examination, choroidal thickness (CT), retinal thickness (RT), choroidal vascularity index (CVI), retinal capillary density index (CDI) and arteriovenous ratio (AVR) were recorded. The patients were divided into two groups - mild (Group A; 5 patients) and moderately severe/severe (Group B; 55 patients) as per revised Atlanta classification.

Results: Fundus examination showed mild optic disc edema with retinal hemorrhages in 6 (10%) patients in group B as compared to none in group A (p = 1.00). None of the patients had Purtscher retinopathy. Mean CT (317 ± 56.29 μm) was increased as compared to normal subjects (278.90 ± 57.84 μm, p = 0.003). The mean CVI (0.62 ± 0.04) was decreased as compared to normal (0.66 ± 0.01, p < 0.0001) as was the mean AVR (0.67 ± 0.03 vs. 0.7 ± 0.02, p < 0.0001). However, the mean RT of subjects with AP (239.68 ± 33.76 μm) was not significantly different compared to the normal subjects 253.17 ± 33.67 µm (p=NS). The mean CDI of superficial and deep plexus were comparable between normal and patients with AP. CT, RT, CVI, AVR and CDI were comparable between group A and group B as well as survivors and non-survivors.

Conclusions: Clinically significant ocular changes are seen infrequently in AP. However, subclinical changes in CT, CVI and AVR are observed in patients with AP compared to normal individuals.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.pan.2020.10.037DOI Listing
December 2020

Differentiating benign and malignant pancreatic masses: Ga-68 PSMA PET/CT as a new diagnostic avenue.

Eur Radiol 2021 Apr 1;31(4):2199-2208. Epub 2020 Oct 1.

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

Objective: Differentiation of malignant and benign pancreatic lesions on anatomical imaging is difficult in some cases with overlapping features. Prostate-specific membrane antigen (PSMA) is overexpressed during angioneogenesis in many tumors. We aimed to evaluate the PSMA expression in pancreatic lesions to differentiate these lesions and explore the performance of Ga-68 PSMA-PET/CT vis-a-vis F-18 FDG-PET/CT.

Methods: Patients with pancreatic lesions on conventional imaging were prospectively recruited. All the patients underwent a whole-body F-18 FDG-PET/CT and a regional abdominal Ga-68 PSMA-PET/CT. Focal tracer uptake (FDG or PSMA) on PET images was considered positive. Histopathology and/or cytopathology were considered the reference standard.

Results: A total of forty patients (27 males, mean age 55.3 ± 9.8, range 37-71 years) were enrolled. Of these, 19 were diagnosed as malignant on histopathology/cytology. Patients with benign lesions showed no worsening of symptoms for at least 6 months on follow-up. FDG-PET/CT revealed 17 true-positive (TP), 9 false-positive (FP), 12 true-negative (TN), and 2 false-negative (FN) findings, whereas PSMA-PET/CT had 18 TP, 2 FP, 19 TN, and 1 FN finding. The sensitivity, specificity, PPV, NPV, and accuracy for FDG-PET/CT were 89.5%, 57.1%, 65.4%, 85.7%, and 72.5%, respectively, while for PSMA-PET/CT were 94.7%, 90.5%, 90%, 95%, and 92.5%, respectively. ROC curve analysis showed that the SUVmax value of 4.8 on PSMA-PET/CT could predict the malignant potential of a lesion with a specificity of 90.5% and a sensitivity of 84.2%.

Conclusions: Ga-68 PSMA-PET/CT imaging helped in establishing a non-invasive pre-operative diagnosis of primary pancreatic malignancy with a higher degree of specificity and accuracy compared with FDG-PET/CT.

Key Points: • Conventional imaging such as CT and MRI are unable to reliably differentiate localized malignant pancreatic lesion from benign lesions mimicking malignancy such as mass-forming pancreatitis. • FDG PET/CT helps in detecting malignant foci in view of their increased glucose metabolism. However, it may be falsely positive in inflammatory lesions which may occasionally hinder its ability to differentiate between benign and malignant lesions. • Apart from prostatic malignancy, PSMA is overexpressed in neovasculature of many non-prostatic malignancies. The present study highlights that Ga68 PSMA PET/CT performed better in diagnosing malignancy non-invasively than FDG-PET/CT with a higher PPV (90.5% vs. 65.4%) and accuracy (92.5% vs. 72.5%).
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s00330-020-07318-2DOI Listing
April 2021

Renal doppler changes in patients with acute pancreatitis: A prospective study.

Pancreatology 2020 Oct 18;20(7):1275-1280. Epub 2020 Aug 18.

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

Background: Renal Doppler to assess renal resistive index (RRI) is an attractive option to prognosticate acute kidney injury (AKI) in acute pancreatitis (AP) as it is feasible within scope of point-of-care ultrasound. However, RRI has been infrequently evaluated in AP.

Objective: Prospectively study diagnostic and prognostic performance of RRI in patients with AP.

Methodology: 75 patients with AP were prospectively enrolled and followed till recovery/death. All patients were subjected to renal Doppler and RRI was compared between patients with and without AKI.

Results: Thirty six patients developed AKI and 39 patients did not develop AKI. AKI network stage 1, 2 and 3 AKI was seen in 7(19.4%), 12(33.3%) and 17 (47.2%) patients respectively. Prognostic scoring done at admission by SIRS, modified marshal score, and BISAP scores, as well as duration of hospitalization and mortality rates were significantly higher in patients with AKI. Mean peak systolic velocity and RRI at upper, middle and lower poles of bilateral kidneys were comparable between patients with and without AKI. The RRI was abnormal in 46 (66.6%) patients and it was <0.6 in 35/46 (76%) and >0.7 in 11/46 (24%) patients respectively. RRI <0.6 was observed in 16 (53.3%) and 19 (48.7%) patients with and without AKI respectively (p = 0.80). RRI >0.7 was observed in 4 (53.3%) and 7 (48.7%) patients with and without AKI respectively (p = 0.74).

Conclusions: AKI is associated with poor prognosis in AP. RRI on renal Doppler at admission seems to have poor diagnostic as well as prognostic performance for AKI in patients with AP.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.pan.2020.08.007DOI Listing
October 2020

Response to letter to editor: Natural history of pancreatic fluid collections: are children different from adults?

Pancreatology 2020 09 5;20(6):1253-1254. Epub 2020 Aug 5.

Division of Paediatric Radiology, Institute of Medical Education & Research, Chandigarh, 160012, India.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.pan.2020.07.404DOI Listing
September 2020

Disconnected pancreatic duct syndrome: Updated review on clinical implications and management.

Pancreatology 2020 Sep 31;20(6):1035-1044. Epub 2020 Jul 31.

Department of Gastroenterology, Post Graduate Institute of Medical Education and Research (PGIMER), Sector 12, Chandigarh, 160012, India. Electronic address:

Disconnected Pancreatic Duct Syndrome (DPDS) is an important but often overlooked complication of acute necrotising pancreatitis (ANP) that occurs due to necrosis of the main pancreatic duct (PD). This segmental necrosis leads on to disconnection between the viable upstream pancreatic parenchyma and the duodenum. The disconnected and functional segment of pancreas continues to secrete pancreatic juice that is not drained into the gastrointestinal tract and lead on to recurrent pancreatic fluid collections (PFC), refractory external pancreatic flstulae and chronic abdominal pain/recurrent pancreatitis. Because of lack of awareness of this important complication of ANP, the diagnosis of DPDS is usually delayed. The delay in diagnosis increases the morbidity of the disease as well as increase the cost of treatment and duration of hospital stay. Surgery has remained the cornerstone for management of patients with DPDS. The conventional surgical approaches have been either resection or internal drainage procedures. Surgery for DPDS in the setting of ANP is often difficult due to presence of local inflammation and extensive venous collaterals in the operative field due to splenic vein thrombosis and therefore is associated with significant morbidity. Advancement in therapeutic endoscopy, especially advent of therapeutic endoscopic ultrasound has opened an exciting new field of minimally invasive therapeutic options for management of DPDS. The present review discusses the current understanding of the clinical manifestations, imaging features and management strategies in patients with DPDS.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.pan.2020.07.402DOI Listing
September 2020

Reply to Letter to Editor-"Catheter-Related Complications of Percutaneous Drainage in Step-up Approach for Management of Pancreatic Necrosis".

J Gastrointest Surg 2020 10 15;24(10):2431-2432. Epub 2020 Jun 15.

Division of Surgical Gastroenterology, Department of General Surgery, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s11605-020-04685-5DOI Listing
October 2020

Acute respiratory distress syndrome in acute pancreatitis.

Indian J Gastroenterol 2020 04 13;39(2):123-132. Epub 2020 Apr 13.

Department of Gastroenterology, Post Graduate Institute of Medical Education and Research, Sector 12, Chandigarh, 160 012, India.

Development of organ failure is one of the major determinants of mortality in patients with acute pancreatitis (AP). Acute respiratory distress syndrome (ARDS) is an important cause of respiratory failure in AP and is associated with high mortality. Pathogenesis of ARDS in AP is incompletely understood. Release of various cytokines plays an important role in development of ARDS in AP. Increased gut permeability due to various toxins, inflammatory mediators, and pancreatic enzymes potentiates lung injury by gut-lymph-lung axis leading on to increased translocation of bacterial endotoxins. Various scoring systems, serum levels of various cytokines and lung ultrasound have been evaluated for prediction of development of ARDS in AP with varying results. Various drugs have shown encouraging results in prevention of ARDS in animal models but these encouraging results in animal models are yet to be confirmed in clinical studies. There is no specific effective treatment for ARDS. Treatment of sepsis and local complications of AP should be done according to the standard management strategies. Lung protective ventilatory strategies are of paramount importance to improve outcome of patients of AP with ARDS and therefore effective coordination between gastroenterologists and intensivists is needed for effective management of these patients.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s12664-020-01016-zDOI Listing
April 2020

Paediatric acute pancreatitis: Clinical profile and natural history of collections.

Pancreatology 2020 Jun 13;20(4):659-664. Epub 2020 Mar 13.

Division of Paediatric Radiology, Post Graduate Institute of Medical Education & Research, Chandigarh, 160012, India.

Background & Aims: Acute Pancreatitis (AP) tends to have a benign course in children. However there is a paucity of information with respect to severity of AP in children, the categorization of collections viz., walled off necrosis (WON)& pseudocyst and their natural history & outcomes.

Methods: A retrospective medical record review of 187 children with pancreatitis diagnosed and managed at our centre was performed.

Results: 101 children (59% boys, Median age 9yrs) had AP of which 37.6%, 60.4% and 2% had mild, moderately severe and severe AP. 61.4%(62) had PFC at diagnosis; 34%(21) acute pancreatic fluid collections (APFC) and 66%(41) acute necrotic collections (ANC). 52.3%(11of21) of APFC evolved into pseudocysts & 68.2%(28of41) of ANC into WON's. Drainage was required in 31%(12of39) of persisting collections, more frequently in children with traumatic AP. Percutaneous catheter drainage (PCD) was done in 6 children and endoscopic ultrasound (EUS) guided cystogastrostomy with placement of plastic or self expanding metal stents (SEMS) in 6 children.

Conclusions: Moderately severe AP is common in hospitalized children with AP with PFC developing in 61.4%, majority being APFC. 48% of APFC and 32% of ANC will resolve and the rest evolve into pseudocyst or WON. Spontaneous resolution is more likely in children with non -traumatic AP having pseudocysts rather than WON's.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.pan.2020.03.007DOI Listing
June 2020

Ascites: an unusual presentation of eosinophilic gastroenteritis in a child.

Trop Doct 2020 Jul 16;50(3):277-279. Epub 2020 Mar 16.

Professor and Head, Division of Paediatric Gastroenterology, Post Graduate Institute of Medical Education & Research, Chandigarh, India.

Eosinophilic ascites, owing to serosal involvement, is a very rare manifestation of eosinophilic gastroenteritis in children, especially when it occurs with muscular involvement in the absence of mucosal disease, which may be confirmed by endoscopic ultrasonography. An 11-year-old girl, presenting with massive eosinophilic ascites and colicky abdominal pain with peripheral eosinophilia, raised IgE levels and positive skin prick test, had such investigation which confirmed the presence of muscle layer thickening of both stomach and small bowel. She responded well to steroids and montelukast.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1177/0049475520911230DOI Listing
July 2020

Endoscopic retrieval of two proximally migrated plastic pancreatic duct stents.

JGH Open 2020 Feb 12;4(1):97-98. Epub 2019 Mar 12.

Department of Surgery Post Graduate Institute of Medical Education and Research (PGIMER) Chandigarh India.

Plastic stent migration is an important complication of pancreatic duct (PD) stenting, with distal (downstream) migration being more common than proximal (upstream) migration. While the distal stent migration into the duodenum is rarely of any clinical consequence, proximal stent migration can cause serious complications, including obstructive pancreatitis. The endoscopic removal of proximally migrated stents is difficult because of the small diameter of PD, the bended and sometimes tortuous course of PD, the presence of strictures, and a lack of dedicated endoscopic accessories. We report a rare case of endoscopic retrieval of two proximally migrated plastic stents from PD.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1002/jgh3.12168DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7008168PMC
February 2020

Immunoglobulin G4-related disease mimicking gallbladder cancer with associated choledochal cyst: A case report of a malignant masquerade.

JGH Open 2019 Dec 22;3(6):536-539. Epub 2019 Feb 22.

Division of Surgical Gastroenterology, Department of General Surgery Postgraduate Institute of Medical Education and Research Chandigarh India.

Immunoglobulin G4 (IgG4)-related disease is a recently described autoimmune disease that can involve diverse organ systems, causing pancreatitis, cholangitis, retroperitoneal fibrosis, and thyroiditis to name a few. Key histological features include storiform fibrosis, obliterative venulitis, and intense inflammatory infiltrate composed of lymphoplasmacytic cells. The disease has a tendency to present with mass-forming lesions, often difficult to differentiate from malignant processes. We report the case of a 48-year-old male from an area endemic for gallbladder cancer (north India). He presented with a short history of abdominal pain and was found to have asymmetric thickening of the gallbladder wall with a soft-tissue mass invading the adjacent liver. In addition, the bile duct was dilated throughout its extent. A clinical and radiological diagnosis of gallbladder cancer with choledochal cyst was made, and the patient underwent radical cholecystectomy with bile duct excision. Histopathology surprisingly demonstrated IgG4-related disease with no evidence of malignancy. Notably, serum levels of immunoglobulins were found to be normal. Preoperative diagnosis was challenging due to the absence of other manifestations. IgG4-related disease is a possible diagnostic pitfall and should be included as a possible differential diagnosis for gallbladder masses.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1002/jgh3.12154DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6891023PMC
December 2019

Pleural metastasis detected by transesophageal endoscopic ultrasonography.

JGH Open 2019 Oct 8;3(5):441-443. Epub 2019 Feb 8.

Department of Surgery Post Graduate Institute of Medical Education and Research (PGIMER) Chandigarh India.

Patients with pleural effusion and inconclusive repeated pleural fluid biochemical and cytological analysis are a diagnostic dilemma that is usually solved by invasive procedures such as diagnostic thoracoscopy. We report a 62-year-old male with malignant pleural effusion as well as ascites who was diagnosed using endoscopic ultrasound-guided fine-needle aspiration of pleural deposit. We also report contrast enhanced endoscopic ultrasound findings of pleural deposits.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1002/jgh3.12151DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6788366PMC
October 2019

An international, multi-institution survey of the use of EUS in the diagnosis of pancreatic cystic lesions.

Endosc Ultrasound 2019 Nov-Dec;8(6):418-427

Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands.

Background And Objectives: Currently, pancreatic cystic lesions (PCLs) are recognized with increasing frequency and have become a more common finding in clinical practice. EUS is challenging in the diagnosis of PCLs and evidence-based decisions are lacking in its application. This study aimed to develop strong recommendations for the use of EUS in the diagnosis of PCLs, based on the experience of experts in the field.

Methods: A survey regarding the practice of EUS in the evaluation of PCLs was drafted by the committee member of the International Society of EUS Task Force (ISEUS-TF). It was disseminated to experts of EUS who were also members of the ISEUS-TF. In some cases, percentage agreement with some statements was calculated; in others, the options with the greatest numbers of responses were summarized.

Results: Fifteen questions were extracted and disseminated among 60 experts for the survey. Fifty-three experts completed the survey within the specified time frame. The average volume of EUS cases at the experts' institutions is 988.5 cases per year.

Conclusion: Despite the limitations of EUS alone in the morphologic diagnosis of PCLs, the results of the survey indicate that EUS-guided fine-needle aspiration is widely expected to become a more valuable method.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.4103/eus.eus_61_19DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6927137PMC
September 2019

Complications of endoscopic ultrasound-guided transmural drainage of pancreatic fluid collections and their management.

Ann Gastroenterol 2019 Sep-Oct;32(5):441-450. Epub 2019 Jul 22.

Department of Surgery (Rajesh Gupta), Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India.

The development of endoscopic ultrasound (EUS)-guided drainage techniques and lumen-apposing metal stents (LAMS) has markedly reduced the complication rate of endoscopic transmural drainage of pancreatic collections and made these procedures safer and more effective. Despite its improved safety profile, various types of complications, some even life-threatening, can occur after EUS-guided drainage of pancreatic fluid collections. Stent maldeployment/migration, bleeding, gastrointestinal perforation, and air embolism are important complications of EUS-guided drainage of pancreatic collections. Delayed complications weeks after the procedure, such as bleeding and buried LAMS due to the presence of prolonged indwelling transmural stents, have also been described. Careful patient selection, with proper assessment of the size, solid necrotic content and location of the collection, as well as an in-depth understanding of various risk factors that predict complications, are important for a safer and more effective endoscopic transmural drainage. For a better clinical outcome, it is important for the endoscopist to know about various complications of EUS-guided drainage of pancreatic collections, as well as their appropriate management strategies.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.20524/aog.2019.0404DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6686089PMC
July 2019

Pancreatic parenchymal calcification induced by permanent indwelling transmural stent.

JGH Open 2019 Jun 11;3(3):264-265. Epub 2019 Feb 11.

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

Long-term transmural stent placement is a safe and effective strategy for the prevention of recurrence of pancreatic fluid collection in patients with walled-off necrosis and disconnected pancreatic duct syndrome. The presence of a stent for an indefinite period has been shown to be safe without any serious adverse effects. We report a rare case of pancreatic parenchymal calcification induced by long-term transmural stent.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1002/jgh3.12133DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6586566PMC
June 2019

Unusual tubular cystic lesion compressing inferior vena cava.

JGH Open 2019 Apr 8;3(2):182-184. Epub 2019 Jan 8.

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

Fluid collections are important local complications of acute pancreatitis (AP). They are usually located in peri-pancreatic region but can also be found in various atypical locations like mediastinum, spleen, liver, pelvis or neck. Such pancreatic fluid collections in atypical locations can cause diagnostic dilemma and may cause delay in management. We report an interesting case of AP who presented to us with a walled-off necrosis mimicking a long cystic mass lesion surrounding the IVC.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1002/jgh3.12126DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6487822PMC
April 2019

Endoscopic management of pancreatic ascites due to duct disruption following acute necrotizing pancreatitis.

JGH Open 2019 Apr 12;3(2):111-116. Epub 2018 Dec 12.

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

Background And Aim: Acute necrotizing pancreatitis (ANP) can be associated with pancreatic duct (PD) disruption. PD disruption can lead to the formation of internal fistulae and consequent pancreatic ascites. Pancreatic ascites is reported very rarely following ANP, and therefore, the role of endotherapy in this setting is not defined. To retrospectively study the safety and efficacy of endoscopic drainage in patients with pancreatic ascites following ANP.

Methods: Over a period of 6 years, 12 patients (10 males; mean age: 35.9 ± 7.1 years) with pancreatic ascites following ANP underwent an attempted endoscopic drainage. Patients with a coexistent pancreatic fluid collection (PFC) underwent endoscopic ultrasound (EUS)-guided transmural drainage of PFC whereas patients with pancreatic ascites alone underwent transpapillary drainage alone.

Results: Nine (75%) patients had coexistent PFC, whereas three patients presented with ascites only. The mean size of PFC was 7.2 ± 1.6 cm. Patients with PFC underwent successful EUS-guided transmural drainage (multiple plastic stents in eight and metal stent in one patient) with complete resolution of PFC as well as ascites within 2-3 weeks. Of three patients with ascites alone, one patient had complete PD disruption, whereas two patients had partial PD disruption. Both patients with partial disruption underwent successful placement of bridging transpapillary stent and resolution of ascites at 6 weeks. In patients with complete disruption, a nonbridging stent was placed into the disruption, and ascites resolved after 8 weeks. There has been no recurrence over 27.5 ± 17.7 weeks.

Conclusion: Endoscopic drainage is a safe and effective treatment modality for the treatment of pancreatic ascites following ANP.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1002/jgh3.12113DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6487829PMC
April 2019

Significance of ileal and/or cecal wall thickening on abdominal computed tomography in a tropical country.

JGH Open 2019 Feb 22;3(1):46-51. Epub 2018 Oct 22.

Department of Surgery Post Graduate Institute of Medical Education and Research (PGIMER) Chandigarh India.

Background And Aim: Clinical significance of ileocecal thickening on computed tomography (CT) is uncertain. We conducted this prospective study to determine the clinical relevance of ileal and/or cecal thickening on CT.

Methods: All patients with ileocecal thickening on CT were prospectively evaluated with ileocolonoscopy, biopsy, and other relevant investigations.

Results: Fifty patients (29 males, mean age 36.8 ± 13.21 years) were studied. Thirty nine (78%) patients presented with abdominal pain. On CT, 46 (92%) had a thickened wall of terminal ileum, 25 (50%) cecum, and 21 (42%) of both cecum and ileum. The mean wall thickness of ileum and cecum on CT was 7.23 + 3.2 mm and 5.5 + 3.1 mm, respectively. Final diagnosis was tuberculosis in 24 (48%) patients, Crohn's disease (CD) in 10 (20%), and adenocarcinoma in 1 patient. Colonoscopy demonstrated abnormal findings in 41 patients (82% patients with mucosal ulcerations being most common ( = 20 (40%). Of 15 (30%) patients with ileocecal bowel wall thickening, 4 (8%) patients had normal colonoscopy and histopathology (incidental ileocecal wall thickening), and in the remaining 11 patients, histopathology showed non-specific findings and these patients were asymptomatic without any specific treatment on last follow up ranging from 3 to 24 months. Involvement of cecum with ileocecal junction, ascending colon involvement, peri-ileocecal stranding, and long-segment stricture was significantly more common in patients with underlying disease as compared to nondiseased patients ( < 0.05).

Conclusion: A majority of patients with ileocecal wall thickening on CT have an underlying disease and should be further investigated by ileocolonoscopy and biopsy.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1002/jgh3.12103DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6386737PMC
February 2019

Frequency & predictors of pancreatitis in symptomatic primary hyperparathyroidism.

Indian J Med Res 2018 Dec;148(6):721-727

Department of Endocrinology, Postgraduate Institute of Medical Education & Research, Chandigarh, India.

Background & Objectives: The frequency and predictors of pancreatitis in primary hyperparathyroidism (PHPT) are not well understood. The objective of the present study was to evaluate the frequency of pancreatitis in patients with PHPT and its association with clinical and biochemical parameters of the disease.

Methods: In this retrospective study all consecutive patients with PHPT registered in the PHPT registry (www.indianphptregistry.com) from the year 2004 to 2013 were included. The clinical, biochemical and radiological parameters related to pancreatitis were evaluated in histologically proven PHPT patients.

Results: A total of 218 patients (63 men; mean age: 40.6±14.4 yr) underwent surgery for PHPT during the study. Pancreatitis occurred in 35 [16%, 18 acute and 17 chronic pancreatitis (CP)] patients and male:female ratio was 1:0.94. Skeletal manifestations were seen less frequently in PHPT with pancreatitis as compared to that of PHPT without pancreatitis. PHPT with pancreatitis had significantly higher serum calcium (12.4±2.0 vs. 11.7±1.5 mg/dl, P <0.05) in comparison to PHPT without pancreatitis. PHPT with acute pancreatitis (AP) had higher serum calcium (P <0.05) and parathyroid hormone (PTH) (P <0.05) levels than PHPT with CP. Curative parathyroidectomy improved the symptoms associated with pancreatitis as there was no recurrence in AP group, whereas recurrence was observed only in about 10 per cent patients of the CP group.

Interpretation & Conclusions: Pancreatitis was observed in 16 per cent of PHPT patients with male predominance in the study population. No recurrence of AP was observed after curative surgery. It may be proposed that serum amylase with calcium and PTH should be measured in all patients of PHPT with pain abdomen to rule out pancreatitis.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.4103/ijmr.IJMR_353_16DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6396558PMC
December 2018

Endoscopic Ultrasound-Guided Tissue Acquisition: Techniques and Challenges.

J Cytol 2019 Jan-Mar;36(1):1-7

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

Endoscopic ultrasound-guided fine needle aspiration (EUS FNA) has made pathological diagnosis of pancreatic neoplasms, diseases involving lymph nodes at various mediastinal and abdominal sites, gastrointestinal submucosal lesions, perirectal lesions, adrenal lesions, and mediastinal masses easy. EUS-guided FNA is a multistep procedure that involves assessment of proper clinical indication, correct selection of FNA needles, and adoption of evidence-based techniques for tissue sampling. EUS FNA is done by needles that are available in different sizes, mainly 25, 22, and 19-gauge needle. The need of onsite cytopathologist, dependence on histology/core biopsy occasionally to get a diagnosis, and inability to reliably assess for molecular markers are important limitations of EUS FNA. EUS-guided fine needle biopsy (FNB) that samples the core of tissue is an exciting new development in the field of diagnostic EUS. FNB needles are expensive than FNA needles, and although the initial results are encouraging, more studies with robust evidence proving their superiority beyond any doubt are needed before they can be widely used.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.4103/JOC.JOC_146_18DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6343389PMC
February 2019

A multi-institution consensus on how to perform EUS-guided biliary drainage for malignant biliary obstruction.

Endosc Ultrasound 2018 Nov-Dec;7(6):356-365

Department of Endoscopy, Yokohama City University School of Medicine, Yokohama, Japan.

Background And Objectives: EUS-guided biliary drainage (EUS-BD) was shown to be useful for malignant biliary obstruction (MBO). However, there is lack of consensus on how EUS-BD should be performed.

Methods: This was a worldwide multi-institutional survey among members of the International Society of EUS conducted in February 2018. The survey consisted of 10 questions related to the practice of EUS-BD.

Results: Forty-six endoscopists of them completed the survey. The majority of endoscopists felt that EUS-BD could replace percutaneous transhepatic biliary drainage after failure of ERCP. Among all EUS-BD methods, the rendezvous stenting technique should be the first choice. Self-expandable metal stents (SEMSs) were recommended by most endoscopists. For EUS-guided hepaticogastrostomy (HGS), superiority of partially-covered SEMS over fully-covered SEMS was not in agreement. 6-Fr cystotomes were recommended for fistula creation. During the HGS approach, longer SEMS (8 or 10 cm) was recommended. During the choledochoduodenostomy approach, 6-cm SEMS was recommended. During the intrahepatic (IH) approach, the IH segment 3 was recommended.

Conclusion: This is the first worldwide survey on the practice of EUS-BD for MBO. There were wide variations in practice, and randomized studies are urgently needed to establish the best approach for the management of this condition.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.4103/eus.eus_53_18DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6289007PMC
December 2018

Clinical profile and treatment outcomes in autoimmune pancreatitis: a report from North India.

Ann Gastroenterol 2018 Jul-Aug;31(4):506-512. Epub 2018 Apr 28.

Department of Pediatrics (Amit Rawat), Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh India.

Background: Autoimmune pancreatitis (AIP) is a rare disease, and data from countries like India concerning its clinical presentation and long-term outcomes are scarce. We retrospectively evaluated the clinical presentation, imaging features and treatment outcomes of patients with AIP.

Methods: We carried out a retrospective analysis of our database to identify patients diagnosed with and treated for AIP at our unit in a tertiary care hospital in North India.

Results: Eighteen patients with AIP (mean age: 54.9±11.1 years; 13 male) were evaluated. Of these, 9 (50%) patients had probable type 1 AIP, 2 (11%) patients probable type 2 AIP, and 4 (22%) definite type 1 AIP. Patients with type 2 AIP were significantly younger than patients with type 1 (40.0±2.8 vs. 58.4±9.6 years). In type 1 AIP, other organ involvement was observed in 3/18 (17%) patients, whereas both patients with type 2 AIP had coexisting ulcerative colitis. The diagnosis of AIP was made after resective surgery in 6/18 (33.0%) patients. An accurate diagnosis of AIP could be made in all patients who underwent resection or core biopsy, but cytological examination after endoscopic ultrasound-guided fine-needle aspiration could not provide a definitive diagnosis in any patient. Initial treatment with steroids was given to 12 (67%) patients, with a 100% response, but the disease relapsed in 5/13 (38%) patients over a mean follow-up period of 34.2±21.6 weeks.

Conclusion: AIP is not rare in India and the majority of clinical manifestations, imaging features, treatment response and long-term outcomes are similar to those reported in the literature.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.20524/aog.2018.0267DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6033754PMC
April 2018
-->