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  1. Article ; Online: Outcomes of Dilation of Recalcitrant Pancreatic Strictures Using a Wire-Guided Cystotome

    Sridhar Sundaram / Dhaval Choksi / Aditya Kale / Suprabhat Giri / Biswaranjan Patra / Shobna Bhatia / Akash Shukla

    Clinical Endoscopy, Vol 54, Iss 6, Pp 903-

    2021  Volume 908

    Abstract: Background/Aims Pancreatic strictures in chronic pancreatitis are treated using endoscopic retrograde cholangiopancreatography (ERCP) with plastic stent placement. The management of recalcitrant strictures remains a challenge, with the use of a Soehendra ...

    Abstract Background/Aims Pancreatic strictures in chronic pancreatitis are treated using endoscopic retrograde cholangiopancreatography (ERCP) with plastic stent placement. The management of recalcitrant strictures remains a challenge, with the use of a Soehendra stent retriever or a needle knife described in case reports. Here, we discuss our experience with dilation of dominant pancreatic strictures with a 6-Fr cystotome. Methods A retrospective review of an endoscopy database was performed to search for patients with pancreatic strictures recalcitrant to conventional methods of dilation in which a cystotome was used. Technical success was defined as the successful dilation of the stricture with plastic stent placement. Functional success was defined as substantial pain relief or resolution of pancreatic fistulae. Results Ten patients (mean age, 30.8 years) underwent dilation of a dominant pancreatic stricture secondary to chronic pancreatitis, with a 6-Fr cystotome. Seven patients presented with pain. Three patients had pancreatic fistulae (two had pancreatic ascites and one had a pancreaticopleural fistula). The median stricture length was 10 mm (range, 5–25 mm). The head of the pancreas was the most common location of the stricture (60%). Technical and functional success was achieved in all patients. One patient had self-limiting bleeding, whereas another patient developed mild post-ERCP pancreatitis. Conclusions The use of a 6-Fr cystotome (diathermy catheter) can be an alternative method for dilation of recalcitrant pancreatic strictures after the failure of conventional modalities.
    Keywords dilation ; endoscopic retrograde cholangiopancreatography ; pancreatitis ; stents ; Internal medicine ; RC31-1245 ; Diseases of the digestive system. Gastroenterology ; RC799-869
    Subject code 610
    Language English
    Publishing date 2021-11-01T00:00:00Z
    Publisher Hoon Jai Chun
    Document type Article ; Online
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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  2. Article ; Online: Epidemiology and Risk Factors of Portal Venous System Thrombosis in Patients With Inflammatory Bowel Disease

    Hanyang Lin / Zhaohui Bai / Fanjun Meng / Yanyan Wu / Li Luo / Akash Shukla / Eric M. Yoshida / Xiaozhong Guo / Xingshun Qi

    Frontiers in Medicine, Vol

    A Systematic Review and Meta-Analysis

    2022  Volume 8

    Abstract: BackgroundPatients with inflammatory bowel disease (IBD) may be at risk of developing portal venous system thrombosis (PVST) with worse outcomes. This study aims to explore the prevalence, incidence, and risk factors of PVST among patients with IBD ... ...

    Abstract BackgroundPatients with inflammatory bowel disease (IBD) may be at risk of developing portal venous system thrombosis (PVST) with worse outcomes. This study aims to explore the prevalence, incidence, and risk factors of PVST among patients with IBD.MethodsPubMed, Embase, and Cochrane Library databases were searched. All the eligible studies were divided according to the history of colorectal surgery. Only the prevalence of PVST in patients with IBD was pooled if the history of colorectal surgery was unclear. The incidence of PVST in patients with IBD after colorectal surgery was pooled if the history of colorectal surgery was clear. Prevalence, incidence, and risk factors of PVST were pooled by only a random-effects model. Subgroup analyses were performed in patients undergoing imaging examinations. Odds ratios (ORs) with 95% CIs were calculated.ResultsA total of 36 studies with 143,659 patients with IBD were included. Among the studies where the history of colorectal surgery was unclear, the prevalence of PVST was 0.99, 1.45, and 0.40% in ulcerative colitis (UC), Crohn's disease (CD), and unclassified IBD, respectively. Among the studies where all the patients underwent colorectal surgery, the incidence of PVST was 6.95, 2.55, and 3.95% in UC, CD, and unclassified IBD after colorectal surgery, respectively. Both the prevalence and incidence of PVST became higher in patients with IBD undergoing imaging examinations. Preoperative corticosteroids therapy (OR = 3.112, 95% CI: 1.017–9.525; p = 0.047) and urgent surgery (OR = 1.799, 95% CI: 1.079–2.998; p = 0.024) are significant risk factors of PVST in patients with IBD after colorectal surgery. The mortality of patients with IBD with PVST after colorectal surgery was 4.31% (34/789).ConclusionPVST is not rare, but potentially lethal in patients with IBD after colorectal surgery. More severe IBD, indicated by preoperative corticosteroids and urgent surgery, is associated with a higher risk of PVST after colorectal surgery. Therefore, screening for PVST by imaging ...
    Keywords portal venous system thrombosis ; epidemiology ; risk factor ; inflammatory bowel disease ; meta-analysis ; Medicine (General) ; R5-920
    Subject code 610 ; 616
    Language English
    Publishing date 2022-01-01T00:00:00Z
    Publisher Frontiers Media S.A.
    Document type Article ; Online
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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  3. Article ; Online: Prevalence of splenic vein thrombosis and risk of gastrointestinal bleeding in chronic pancreatitis patients attending a tertiary hospital in western India

    Vikas Pandey / Mallangoud Patil / Ruchir Patel / Alisha Chaubal / Meghraj Ingle / Akash Shukla

    Journal of Family Medicine and Primary Care, Vol 8, Iss 3, Pp 818-

    2019  Volume 822

    Abstract: Background: Splenic vein thrombosis (SVT) is most commonly caused by acute and chronic pancreatitis (CP). Variceal gastrointestinal (GI) bleeding is a potentially life-threatening event in such patients. The aim of this study was to determine the ... ...

    Abstract Background: Splenic vein thrombosis (SVT) is most commonly caused by acute and chronic pancreatitis (CP). Variceal gastrointestinal (GI) bleeding is a potentially life-threatening event in such patients. The aim of this study was to determine the prevalence of SVT in CP patients and the risk of variceal GI bleeding. Materials and Methods: A total of 187 consecutive patients with a diagnosis of CP were assessed for the presence of SVT at the gastroenterology department of a tertiary care hospital. Thirty seven patients had evidence of SVT. Patients with portal vein thrombosis or cirrhosis were excluded. Potential factors associated with SVT were assessed. Results: Of the 187 CP patients assessed, 37 patients (19.8%) (male 33; female 4; mean age 41.9 years) had evidence of SVT. Among patients with SVT, most common etiology of CP was alcohol abuse (70.3%). Seven patients (18.9%) with SVT presented with clinically significant upper GI bleeding. The source of GI bleeding was gastric varices in three patients (8.1%) and non-variceal source in four patients (10.8%). All three patients with gastric varices were managed by splenectomy. There were no new variceal bleeding episodes in other 33 patients (89.2%) during mean follow-up of 16.4 months. On comparison of patients with and without SVT, the factors associated with significantly higher incidence of SVT were smoking (P = 0.019, odds ratio 3.021, 95% confidence interval 1.195–7.633) and presence of pseudocyst (P = 0.008, odds ratio 3.743, 95% confidence interval 1.403–9.983). Complete resolution of SVT was seen in three patients (8.1%) after resolution of underlying pseudocyst. Conclusion: SVT is a common complication of CP, particularly in patients with pseudocysts and history of smoking. Most patients remain asymptomatic and the risk of variceal bleeding is low. Splenectomy is the treatment of choice in patients with variceal bleeding. Conservative approach is preferred in other patients. Resolution of pseudocysts may lead to resolution of SVT in some patients.
    Keywords Chronic pancreatitis ; gastrointestinal bleeding ; pseudocysts ; splenic vein thrombosis ; Medicine ; R
    Subject code 610 ; 616
    Language English
    Publishing date 2019-01-01T00:00:00Z
    Publisher Wolters Kluwer Medknow Publications
    Document type Article ; Online
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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  4. Article ; Online: Esophageal carcinoma

    Dhaval Choksi / Kailash M Kolhe / Meghraj Ingle / Chetan Rathi / Harshad Khairnar / Shamshersingh G Chauhan / Vipul Chaudhary / Akash Shukla / Vikas Pandey

    Journal of Family Medicine and Primary Care, Vol 9, Iss 3, Pp 1695-

    An epidemiological analysis and study of the time trends over the last 20 years from a single center in India

    2020  Volume 1699

    Abstract: Background and Aims: Esophageal carcinoma is a common gastrointestinal malignancy. There is a paucity of literature about the time trends from India. The aim of the study was to evaluate the time trends over 20 years and observe how they differ from the ... ...

    Abstract Background and Aims: Esophageal carcinoma is a common gastrointestinal malignancy. There is a paucity of literature about the time trends from India. The aim of the study was to evaluate the time trends over 20 years and observe how they differ from the West. Material and Methods: We retrospectively evaluated the data of 552 patients from the gastroenterology database (single department, single-center) over a period of 20 years from 1996 to 2015. The study period was split into two groups, namely, Group A (1996 to 2005) and Group B (2006 to 2015). Results: There were 263 patients in Group A and 289 patients in Group B. The mean age was 54.83 years (range 25–89 years). There were 345 males and 207 females, with the ratio being 1.67. The most common histological type was squamous cell carcinoma (SCC) with 443 patients (80.25%). The most common location was mid esophagus with 229 patients (41.48%) followed by 208 patients (37.68%) in the lower esophagus. There was no significant increase in the lower esophageal malignancy. However, there was a significant increase in the gastroesophageal junction (GEJ) and adenocarcinoma (AC). There were no other time trend changes in gender, location, or histology. Conclusion: SCC is still far more common than AC in India. The mid esophagus is the most common site. There is no evidence of an increase in the lower esophageal malignancy in our study for over 20 years. However, the rates of GEJ-AC were found to be increasing.
    Keywords adenocarcinoma esophagus ; esophageal carcinoma ; esophagus ; squamous cell carcinoma esophagus ; time trend ; Medicine ; R
    Subject code 616
    Language English
    Publishing date 2020-01-01T00:00:00Z
    Publisher Wolters Kluwer Medknow Publications
    Document type Article ; Online
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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  5. Article: Knowledge and Awareness of the Health Care Workers about the Hepatitis B Infection and their Vaccination Status in a Newly Started Medical College.

    Dev, Kansara / S, Kuyare Sunil / Abhay, Gupta / Gajanan, Khote / Akash, Shukla / Bisure, Kishore

    The Journal of the Association of Physicians of India

    2019  Volume 66, Issue 12, Page(s) 27–30

    Abstract: Introduction: Healthcare workers (HCWs) are at high risk of hepatitis B virus infection (HBI) and so the present study was carried out to assess the knowledge of HCWs in a tertiary care medical college about HBI and hepatitis B vaccine (HBV).: Method!# ...

    Abstract Introduction: Healthcare workers (HCWs) are at high risk of hepatitis B virus infection (HBI) and so the present study was carried out to assess the knowledge of HCWs in a tertiary care medical college about HBI and hepatitis B vaccine (HBV).
    Method: After obtaining approval from Institutional Ethics Committee and informed consent from the study participants, HCWs that included teaching faculty, resident doctors, medical students, nurses, laboratory technicians, administrative staff and support staff (ward boys, attendants and sweepers) were administered a validated questionnaire. Descriptive statistics was applied for the categorical variables and the Chi-square test of association was used to assess the statistical significance of variables.
    Results: A total of 300 HCWs were recruited for the study. Although, the overall knowledge amongst all the HCWs was found to be 68%, only 35.3%HCWs knew the transmission risk by needle stick injury (NSI). Similarly, only 40% correctly knew the precautions to be taken for preventing an NSI and 17% for the steps to be taken to disinfect a blood splash. Almost 92.7% (278/300) HCWs were aware about the availability of a vaccine, of which only 41% (1123/300) knew that vaccine will not work in case the patient is already infected. When asked about the steps to be taken in case of an NSI in non-vaccinated HCWs, only 54.7% (164/300) replied about treatment with both immunoglobulin and vaccination. A total of 160 (53.3%) HCWs were found to be vaccinated. The most common reason for not taking vaccination included an improper understanding of HBV and the infection it causes.
    Conclusion: To conclude, the study highlights good knowledge about hepatitis B infection with requirement of more emphasis on the practical aspects of management in a case of NSI/blood splash and can guide to improve the vaccination status and knowledge of HBI amongst HCWs.
    MeSH term(s) Cross-Sectional Studies ; Health Knowledge, Attitudes, Practice ; Health Personnel ; Hepatitis B ; Hepatitis B Vaccines ; Humans ; Male ; Vaccination
    Chemical Substances Hepatitis B Vaccines
    Language English
    Publishing date 2019-07-15
    Publishing country India
    Document type Journal Article
    ZDB-ID 800766-4
    ISSN 0004-5772
    ISSN 0004-5772
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  6. Article ; Online: Multiple Extrasplanchnic Venous Thromboses

    Hardik Parikh / Akash Shukla / Shobna Bhatia / Yashant Aswani

    JOP Journal of the Pancreas, Vol 13, Iss 3, Pp 317-

    A Rare Complication of Pancreatitis. A Case Report

    2012  Volume 319

    Abstract: Context Venous thrombosis has been described in patients with acute and chronic pancreatitis. This is especially common in portal vein, splenic vein and superior mesenteric vein. To the best of our knowledge, involvement of superior vena cava and ... ...

    Abstract Context Venous thrombosis has been described in patients with acute and chronic pancreatitis. This is especially common in portal vein, splenic vein and superior mesenteric vein. To the best of our knowledge, involvement of superior vena cava and subclavian vessel due to pancreatitis has not been reported. Case report We present here a case of an adult male with alcoholic chronic pancreatitis who presented with multiple vessel thromboses involving superior vena cava, inferior vena cava, bilateral subclavian, internal jugular vein, axillary, iliac and renal vein without involvement of portal, splenic and superior mesenteric vein that was effectively treated with i.v. anticoagulation therapy. Conclusion Venous thromboses can occur outside the splanchnic circulation in pancreatitis.
    Keywords Pancreatic Fistula ; Pancreatitis ; Alcoholic ; Venous Thrombosis ; Medicine ; R ; Internal medicine ; RC31-1245 ; Specialties of internal medicine ; RC581-951 ; Diseases of the digestive system. Gastroenterology ; RC799-869
    Publishing date 2012-05-01T00:00:00Z
    Publisher E S Burioni Ricerche Bibliografiche
    Document type Article ; Online
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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