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Vadgaonkar A, Kamat N, Parekh S, Patil G, Dalal A, Maydeo A. Oesophageal perforation by migrated Ryles tube. Trop Doct 2024:494755241241832. [PMID: 38562095 DOI: 10.1177/00494755241241832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
A 72-year woman with a history of multiple cerebrovascular accidents presented with severe epigastric pain. An oesophageal perforation by the tip of a Ryles tube, which had migrated into the mediastinum, was diagnosed by radiography. An attempt at pushing the nasogastric tube into the stomach resulted in increasing the rupture to about 6 cm in size. Replacement by a triple-lumen nasojejunal feeding tube and subsequent feeding with c.1,400 calories per day enabled the perforation to close without further intervention.
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Affiliation(s)
- Amol Vadgaonkar
- Consultant, Institute of Gastrosciences, Sir H. N. Reliance Foundation Hospital and Research Centre, Girgaon, Mumbai, Maharashtra, India
| | - Nagesh Kamat
- Senior Research Scientist, Institute of Gastrosciences, Sir H. N. Reliance Foundation Hospital and Research Centre, Girgaon, Mumbai, Maharashtra, India
| | - Sanil Parekh
- Consultant, Institute of Gastrosciences, Sir H. N. Reliance Foundation Hospital and Research Centre, Girgaon, Mumbai, Maharashtra, India
| | - Gaurav Patil
- Consultant, Institute of Gastrosciences, Sir H. N. Reliance Foundation Hospital and Research Centre, Girgaon, Mumbai, Maharashtra, India
| | - Ankit Dalal
- Consultant, Institute of Gastrosciences, Sir H. N. Reliance Foundation Hospital and Research Centre, Girgaon, Mumbai, Maharashtra, India
| | - Amit Maydeo
- Chairman, Institute of Gastrosciences, Sir H. N. Reliance Foundation Hospital and Research Centre, Girgaon, Mumbai, Maharashtra, India
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Maydeo A, Parekh S, Kamat N, Dalal A, Patil G, Vora S, Vadgaonkar A. A Curious Case of Abdominal Pain: What Is Stuck at the Tail? Am J Gastroenterol 2024:00000434-990000000-01045. [PMID: 38372361 DOI: 10.14309/ajg.0000000000002728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Accepted: 12/20/2023] [Indexed: 02/20/2024]
Affiliation(s)
- Amit Maydeo
- Institute of Gastrosciences, Sir H. N. Reliance Foundation Hospital and Research Centre, Girgaon, Mumbai, Maharashtra, India
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Dalal A, Kamat N, Maydeo A, Patil G, Vadgaonkar A, Parekh S, Vora S. Assessment of pancreatic ductal stone density on non-contrast computed tomography for predicting the outcome of extracorporeal shock wave lithotripsy. Endosc Int Open 2024; 12:E274-E281. [PMID: 38420153 PMCID: PMC10901651 DOI: 10.1055/a-2226-1464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 12/05/2023] [Indexed: 03/02/2024] Open
Abstract
Background and study aims The utility of stone density at non-contrast computed tomography (NCCT) for predicting the effectiveness of extracorporeal shock wave lithotripsy (ESWL) in chronic calcific pancreatitis (CCP) is relatively unexplored. Patients and methods This was a prospective observational study of patients with CCP. Hounsfield units (HU) were determined for the largest pancreatic ductal stone during pretreatment NCCT. All patients underwent ESWL until the largest stone was fragmented to <3mm, followed by endoscopic retrograde cholangiopancreatography (ERCP) for stone extraction. The predictive factors following ESWL for successful stone extraction were studied and the receiver operating characteristic (ROC) curve determined the HU optimal cut-point. Results Eighty-two patients with a median (interquartile range) age of 36 years (range, 29-55); majority male 45 (54.9%), were included. Idiopathic CCP was noted in 78 patients (95.1%). The median stone density (SD) was 1095 HU (range, 860.7-1260.7) and the number of ESWL sessions was 2 (range, 2-3). Complete stone removal at index ERCP was achieved in 55 patients (67.1%). Those with partial clearance (n=27) needed a repeat ERCP, which was successful in 26 (96.3%); one patient (3.7%) underwent surgery. There was a significant, positive correlation between number of ESWL sessions and SD (r=0.797; P <0.001). On bivariate analysis, SD and the number of ESWL sessions revealed a significant association with complete ductal clearance. The optimal cut-point for complete stone removal by the ROC curve was 1106.5 HU (Youden index 0.726), with a sensitivity of 93% and a specificity of 80%. Conclusions The SD is a significant predictor of ESWL success followed by ductal clearance at ERCP, and <1106.5 HU is a predictor of good candidates for ESWL therapy.
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Affiliation(s)
- Ankit Dalal
- Institute of Gastrosciences, Sir HN Reliance Foundation Hospital and Research Centre, Mumbai, India
| | - Nagesh Kamat
- Institute of Gastrosciences, Sir HN Reliance Foundation Hospital and Research Centre, Mumbai, India
| | - Amit Maydeo
- Institute of Gastrosciences, Sir HN Reliance Foundation Hospital and Research Centre, Mumbai, India
| | - Gaurav Patil
- Institute of Gastrosciences, Sir HN Reliance Foundation Hospital and Research Centre, Mumbai, India
| | - Amol Vadgaonkar
- Institute of Gastrosciences, Sir HN Reliance Foundation Hospital and Research Centre, Mumbai, India
| | - Sanil Parekh
- Institute of Gastrosciences, Sir HN Reliance Foundation Hospital and Research Centre, Mumbai, India
| | - Sehajad Vora
- Institute of Gastrosciences, Sir HN Reliance Foundation Hospital and Research Centre, Mumbai, India
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Dalal A, Kamat N, Patil G, Vadgaonkar A, Parekh S, Vora S, Maydeo A. Comparison of diagnostic outcomes, safety, and cost of Franseen-tip 19G versus 22G needles for endoscopic ultrasound-guided liver biopsies. Endosc Int Open 2024; 12:E291-E296. [PMID: 38420158 PMCID: PMC10901641 DOI: 10.1055/a-2226-1337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 12/01/2023] [Indexed: 03/02/2024] Open
Abstract
Background and study aims Favorable outcomes were noted with refinement in newer endoscopic ultrasound-guided liver biopsy (EUS-LB) needle tips. Still, the overall usefulness and benefit are yet to be well explored. Patients and methods This was a retrospective analysis of patients with EUS-LB (Franseen-tip 19G versus 22G FNB needle) over 2 years. EUS-LB was obtained in a one-pass, two-actuation, modified wet suction technique. Diagnostic yield, fragmentation rate, aggregate specimen length (AL), number of complete portal tracts (CPT), length of longest intact core (LIC), adverse events (AEs) (early), and cost of the procedure (1USD = 82 INR) were compared. Results Fifty-four patients (33 [61.1%], female) successfully underwent EUS-LB with a median age of 46 years (interquartile range [IQR] 34-54); the majority 32 (59.2%) underwent 19G biopsies. There was a significantly increased median (IQR) AL in the 19G compared with 22G (20 mm [19-21] vs. 15 [14-15], P < 0.001), respectively. Similarly, significantly lengthier median LIC and CPT were seen, respectively. A nonsignificant diagnostic yield was noted (100% vs. 90.9%, P = 0.082), respectively. The fragmentation rate was higher in 22G FNB needles (36.4% [95% CI 16-56] vs. 12.5% [95% CI 1-24], respectively; P = 0.038). Seven patients (12.9%) had mild AEs with no difference between groups. The average procedure cost with 19G was INR 63000 (768$), and with 22G needle was INR 54500 (664$). Conclusions The Franseen-tip 19G outperforms 22G with a significantly lower fragmentation rate, longer AL, LIC, and a higher number of CPT with a marginal increase in the procedure cost, without any difference in diagnostic yield and safety.
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Affiliation(s)
- Ankit Dalal
- Institute of Gastrosciences, Sir HN Reliance Foundation Hospital and Research Centre, Mumbai, India
| | - Nagesh Kamat
- Institute of Gastrosciences, Sir HN Reliance Foundation Hospital and Research Centre, Mumbai, India
| | - Gaurav Patil
- Institute of Gastrosciences, Sir HN Reliance Foundation Hospital and Research Centre, Mumbai, India
| | - Amol Vadgaonkar
- Institute of Gastrosciences, Sir HN Reliance Foundation Hospital and Research Centre, Mumbai, India
| | - Sanil Parekh
- Institute of Gastrosciences, Sir HN Reliance Foundation Hospital and Research Centre, Mumbai, India
| | - Sehajad Vora
- Institute of Gastrosciences, Sir HN Reliance Foundation Hospital and Research Centre, Mumbai, India
| | - Amit Maydeo
- Institute of Gastrosciences, Sir HN Reliance Foundation Hospital and Research Centre, Mumbai, India
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Maydeo A, Kamat N, Dalal A, Patil G. Advances in the Management of Pain in Chronic Pancreatitis. Curr Gastroenterol Rep 2023; 25:260-266. [PMID: 37713043 DOI: 10.1007/s11894-023-00898-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/17/2023] [Indexed: 09/16/2023]
Abstract
PURPOSE OF REVIEW The data on recent advances in managing chronic pancreatitis (CP) pain is limited. This review highlights the role of endotherapy and the advances in the overall management of pain in CP. RECENT FINDINGS Of late, pancreatic biodegradable stents have been used in endotherapy with appreciable success. These include slow, medium, and fast degrading stents, which optimize the overall management of CP and could prevent the need for multiple procedures. Endoscopic ultrasound-guided celiac plexus block is reserved in selected patients to treat debilitating pain. Total pancreatectomy with islet autotransplantation in small duct disease has shown promising results. The indications for treating pain in CP with endoscopy and surgery need to be better defined. The complexity of pain control due to the incomplete understanding of pathomorphology makes the management of CP challenging. The current treatment methods are still evolving. Therapy aims to reduce pain, optimize recovery, maintain quality of life, and meet postoperative needs. Initial management includes lifestyle modification, nutrition optimization, risk factor reduction with abstinence from alcohol, cessation of tobacco and smoking. Supportive medical management involves the judicial use of analgesics, neuromodulators, antioxidants, pancreatic enzyme replacement for insufficiency, and diabetes management. Patients with intractable pain are ideal for therapeutic intervention. Being less invasive with an acceptable complication rate makes endotherapy the preferred first-line treatment. If found to be cost-effective, biodegradable stents can reduce the overall cost. Unfortunately, if patients remain symptomatic, surgery is preferred in case of failure or recurrence. For optimal results, appropriate patient selection is vital to maximizing outcomes.
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Affiliation(s)
- Amit Maydeo
- Institute of Gastrosciences, Sir H. N. Reliance Foundation Hospital and Research Centre, Girgaon, Mumbai, Maharashtra, India, 400004.
| | - Nagesh Kamat
- Institute of Gastrosciences, Sir H. N. Reliance Foundation Hospital and Research Centre, Girgaon, Mumbai, Maharashtra, India, 400004
| | - Ankit Dalal
- Institute of Gastrosciences, Sir H. N. Reliance Foundation Hospital and Research Centre, Girgaon, Mumbai, Maharashtra, India, 400004
| | - Gaurav Patil
- Institute of Gastrosciences, Sir H. N. Reliance Foundation Hospital and Research Centre, Girgaon, Mumbai, Maharashtra, India, 400004
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Maydeo A, Patil G, Kamat N, Dalal A, Vadgaonkar A, Parekh S, Daftary R, Vora S. Endoscopic full-thickness plication for the treatment of gastroesophageal reflux after peroral endoscopic myotomy: a randomized sham-controlled study. Endoscopy 2023; 55:689-698. [PMID: 36944359 PMCID: PMC10374353 DOI: 10.1055/a-2040-4042] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Accepted: 02/01/2023] [Indexed: 03/23/2023]
Abstract
BACKGROUND : Endoscopic full-thickness plication (EFTP) has shown promising results in gastroesophageal reflux disease (GERD), but its efficacy in GERD after peroral endoscopic myotomy (POEM) is unclear. METHODS : In a prospective, randomized trial of post-POEM patients dependent on proton pump inhibitors (PPIs) for documented GERD, patients underwent EFTP (plication to remodel the gastroesophageal flap valve) or an endoscopic sham procedure (positioning of the EFTP device, but no stapling). The primary end point was improvement in acid exposure time (AET) < 6 % (3 months). Secondary end points included improvement in esophagitis (3 months), GERD Questionnaire (GERDQ) score (3 and 6 months), and PPI usage (6 months). RESULTS : 60 patients were randomized (30 in each group). At 3 months, a significantly higher proportion of patients achieved improvement in AET < 6 % in the EFTP group compared with the sham group (69.0 % [95 %CI 52.1-85.8] vs. 10.3 % [95 %CI 0-21.4], respectively). EFTP was statistically superior to sham (within-group analysis) in improving esophageal AET, DeMeester Score, and all reflux episodes (P < 0.001). A nonsignificant improvement in esophagitis was noted in the EFTP group (P = 0.14). Median GERDQ scores (3 months) were significantly better (P < 0.001) in the EFTP group, and the same trend continued at 6 months. A higher proportion of patients in the sham group continued to use PPIs (72.4 % [95 %CI 56.1-88.7] vs. 27.6 % [95 %CI 11.3-43.8]). There were no major adverse events in either group. CONCLUSION : EFTP improved post-POEM GERD symptoms, 24-hour pH impedance findings with normalization in one-third, and reduced PPI usage at 6 months.
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Affiliation(s)
- Amit Maydeo
- Baldota Institute of Digestive Sciences, Gleneagles Global Hospital, Mumbai, Maharashtra, India
| | - Gaurav Patil
- Baldota Institute of Digestive Sciences, Gleneagles Global Hospital, Mumbai, Maharashtra, India
| | - Nagesh Kamat
- Baldota Institute of Digestive Sciences, Gleneagles Global Hospital, Mumbai, Maharashtra, India
| | - Ankit Dalal
- Baldota Institute of Digestive Sciences, Gleneagles Global Hospital, Mumbai, Maharashtra, India
| | - Amol Vadgaonkar
- Baldota Institute of Digestive Sciences, Gleneagles Global Hospital, Mumbai, Maharashtra, India
| | - Sanil Parekh
- Baldota Institute of Digestive Sciences, Gleneagles Global Hospital, Mumbai, Maharashtra, India
| | - Rajen Daftary
- Baldota Institute of Digestive Sciences, Gleneagles Global Hospital, Mumbai, Maharashtra, India
| | - Sehajad Vora
- Baldota Institute of Digestive Sciences, Gleneagles Global Hospital, Mumbai, Maharashtra, India
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Vengurlekar D, Walker C, Mahajan R, Dalal A, Chavan V, Galindo MA, Iyer A, Mansoor H, Silsarma A, Isaakidis P, Spencer H. Linezolid resistance in patients with drug-resistant TB. Int J Tuberc Lung Dis 2023; 27:567-569. [PMID: 37353865 DOI: 10.5588/ijtld.22.0632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/25/2023] Open
Affiliation(s)
- D Vengurlekar
- Médecins Sans Frontières (MSF) Operational Centre Brussels, Mumbai, India
| | - C Walker
- MSF Operational Centre Brussels, Southern Africa Medical Unit, Cape Town, South Africa, MSF Luxembourg Operational Research Unit (LuxOR), Luxembourg, Luxembourg
| | - R Mahajan
- MSF Operational Centre Barcelona-Athens, New Delhi, India
| | - A Dalal
- Jupiter Hospital, Mumbai, India
| | - V Chavan
- Médecins Sans Frontières (MSF) Operational Centre Brussels, Mumbai, India
| | - M A Galindo
- Médecins Sans Frontières (MSF) Operational Centre Brussels, Mumbai, India
| | - A Iyer
- Médecins Sans Frontières (MSF) Operational Centre Brussels, Mumbai, India
| | - H Mansoor
- Médecins Sans Frontières (MSF) Operational Centre Brussels, Mumbai, India
| | - A Silsarma
- Médecins Sans Frontières (MSF) Operational Centre Brussels, Mumbai, India
| | - P Isaakidis
- MSF Operational Centre Brussels, Southern Africa Medical Unit, Cape Town, South Africa, Clinical and Molecular Epidemiology Unit, Department of Hygiene and Epidemiology, University of Ioannina School of Medicine, Ioannina, Greece
| | - H Spencer
- MSF Operational Centre Brussels, Southern Africa Medical Unit, Cape Town, South Africa
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Rai P, Udawat P, Chowdhary SD, Gunjan D, Samanta J, Bhatia V, Singla V, Mukewar S, Mehta N, Achanta CR, Dalal A, Sahu MK, Balekuduru A, Bale A, Basha J, Philip M, Rana S, Puri R, Lakhtakia S, Dhir V. Society of Gastrointestinal Endoscopy of India Consensus Guidelines on Endoscopic Ultrasound-Guided Biliary Drainage: Part I (Indications, Outcomes, Comparative Evaluations, Training). Journal of Digestive Endoscopy 2023. [DOI: 10.1055/s-0043-1761591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/05/2023] Open
Abstract
AbstractEndoscopic management of bile duct obstruction is a key aspect in gastroenterology practice and has evolved since the first description of biliary cannulation by McCune et al in 1968. Over many decades, the techniques and accessories have been refined and currently, the first-line management for extrahepatic biliary obstruction is endoscopic retrograde cholangiopancreaticography (ERCP). However, even in expert hands the success rate of ERCP reaches up to 95%. In almost 4 to 16% cases, failure to cannulate the bile duct may necessitate other alternatives such as surgical bypass or more commonly percutaneous transhepatic biliary drainage (PTBD). While surgery is associated with high morbidity and mortality, PTBD has a very high reintervention and complication rate (∼80%) and poor quality of life. Almost parallelly, endoscopic ultrasound (EUS) has come a long way from a mere diagnostic tool to a substantial therapeutic option in various pancreatico-biliary diseases. Biliary drainage using EUS-guidance (EUS-BD) has gained momentum since the first report published by Giovannini et al in 2001. The concept of accessing the bile duct through a different route than the papilla, circumventing the shortcomings of PTBD and sometimes bypassing the actual obstruction have enthused a lot of interest in this novel strategy. The three key methods of EUS-BD entail transluminal, antegrade, and rendezvous approach. Over the past decade, with growing experience, EUS-BD has been found to be equivalent to ERCP or PTBD for malignant obstruction with better success rates.EUS-BD, albeit, is not devoid of adverse events and can carry fatal adverse events. However, neither the technique of EUS-BD, nor the accessories and stents for EUS-BD have been standardized.Additionally, different countries and regions have different availability of the accessories making generalizability a difficult task. Thus, technical aspects of this evolving therapy need to be outlined. For these reasons, the Society of Gastrointestinal Endoscopy India deemed it appropriate to develop technical consensus statements for performing safe and successful EUS-BD.
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Affiliation(s)
- Praveer Rai
- Department of Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Priyanka Udawat
- Institute of Digestive and Liver Care, School of EUS, S. L. Raheja Hospital, Mumbai, Maharashtra, India
| | | | - Deepak Gunjan
- Department of Gastroenterology and Human Nutrition Unit, All India Institute of Medical Sciences, New Delhi, India
| | - Jayanta Samanta
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Vikram Bhatia
- Department of Hepatology, Institute of Liver and Biliary Sciences, New Delhi, India
| | - Vikas Singla
- Department of Gastroenterology, Max Superspeciality Hospital, New Delhi, India
| | | | - Nilay Mehta
- Department of Gastroenterology, Zydus Hospital, Ahmedabad, Gujarat, India
| | - Chalapathi Rao Achanta
- Department of Gastroenterology, KIMS ICON Hospital, Vishakhapatnam, Andhra Pradesh, India
| | - Ankit Dalal
- Baldota Institute of Digestive Sciences, Global Hospital, Mumbai, Maharashtra, India
| | - Manoj Kumar Sahu
- Institute of GI Sciences, Apollo Hospitals, Bhubaneshwar, Orissa, India
| | - Avinash Balekuduru
- Department of Gastroenterology, MS Ramaiah Medical College and Hospital, Bengaluru, Karnataka, India
| | - Abhijit Bale
- Department of Medical Gastroenterology, Sapthagiri Institute of Medical Sciences, Bengaluru, Karnataka, India
| | - Jahangir Basha
- Asian Institute of Gastroenterology, AIG Hospitals, Hyderabad, Telangana, India
| | - Mathew Philip
- Department of Gastroenterology, Lisie Hospital, Kochi, Kerala, India
| | - Surinder Rana
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Rajesh Puri
- Institute of Digestive and Hepatobiliary Sciences, Medanta Hospital, Gurugram, Haryana, India
| | - Sundeep Lakhtakia
- Asian Institute of Gastroenterology, AIG Hospitals, Hyderabad, Telangana, India
| | - Vinay Dhir
- Institute of Digestive and Liver Care, School of EUS, S. L. Raheja Hospital, Mumbai, Maharashtra, India
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Patil G, Dalal A, Kamat N, Vadgaonkar A, Shah A, Vora S, Maydeo AP. Endoscopic management of a migrated biliary stent in the pleura: a rare complication. Endoscopy 2023; 55:E436-E437. [PMID: 36796443 PMCID: PMC9935077 DOI: 10.1055/a-2011-5480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
Affiliation(s)
- Gaurav Patil
- Baldota Institute of Digestive Sciences, Gleneagles Global Hospital, Mumbai, Maharashtra, India
| | - Ankit Dalal
- Baldota Institute of Digestive Sciences, Gleneagles Global Hospital, Mumbai, Maharashtra, India
| | - Nagesh Kamat
- Baldota Institute of Digestive Sciences, Gleneagles Global Hospital, Mumbai, Maharashtra, India
| | - Amol Vadgaonkar
- Baldota Institute of Digestive Sciences, Gleneagles Global Hospital, Mumbai, Maharashtra, India
| | - Animesh Shah
- Baldota Institute of Digestive Sciences, Gleneagles Global Hospital, Mumbai, Maharashtra, India
| | - Sehajad Vora
- Baldota Institute of Digestive Sciences, Gleneagles Global Hospital, Mumbai, Maharashtra, India
| | - Amit P. Maydeo
- Baldota Institute of Digestive Sciences, Gleneagles Global Hospital, Mumbai, Maharashtra, India
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Chieng CY, Dalal A, Ilankovan V. Occupational exposure and risk of oral and oropharyngeal squamous cell carcinoma: systematic review and 25-year retrospective cohort study of patients. Br J Oral Maxillofac Surg 2023; 61:39-48. [PMID: 36443129 DOI: 10.1016/j.bjoms.2022.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 10/23/2022] [Accepted: 11/01/2022] [Indexed: 11/06/2022]
Abstract
Social habits such as smoking and drinking alcohol are well-known causative agents for oral and oropharyngeal squamous cell carcinoma (OSCC/OPSCC). Human papillomavirus (HPV) is a known causative agent for OPSCC. However, we often encounter patients with no identifiable risk factors. There is growing evidence of the role of occupational carcinogens in the pathogenesis of oral cancer. The aim of this study therefore was to identify any occupational carcinogens linked to oral cancer. We carried out a systematic review of the literature using PubMed, EMBASE, and Medline, along with a retrospective review of patients treated in a regional unit over 25 years. Occupations were classified based on the UK Standard of Classification 2020. Data analysis was completed using the chi-squared test. A total of 17 papers met the inclusion criteria for review. In our retrospective study a total of 874 patients were identified of whom 31% were blue-collar workers, 32.8% were white-collar workers, 20.2% were unemployed/housewives, and 16% workers in other occupations. The majority of blue-collar workers were in the construction industry and had maximum exposure to hydrocarbons and exhaust fumes. The aetiology of oral and oropharyngeal SCC is multifactorial and there is no consensus on the role of occupational carcinogens. We showcase our patient cohort and discuss the occupational exposures that appear to make them susceptible to OSCC and OPSCC. Further multicentre studies are required to enable us to understand fully the pathogenesis of oral cancer and help us to inform relevant organisations, the aim being to reduce the incidence of occupation-related cancer.
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Affiliation(s)
- C Y Chieng
- Oral & Maxillofacial Surgery Department, University Hospital Dorset NHS Foundation Trust, United Kingdom.
| | - A Dalal
- Oral & Maxillofacial Surgery Department, University Hospital Dorset NHS Foundation Trust, United Kingdom
| | - V Ilankovan
- Oral & Maxillofacial Surgery Department, University Hospital Dorset NHS Foundation Trust, United Kingdom
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Patil G, Vadgaonkar A, Dalal A, Parekh S, Shah A, Haridas P, Gupte P, Vora S, Maydeo A. Endoscopic Submucosal Dissection for Esophageal Squamous Cell High-grade Dysplasia in a Patient with Plummer Vinson Syndrome. Journal of Digestive Endoscopy 2022. [DOI: 10.1055/s-0042-1759510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
AbstractA 35-year female with Plummer Vinson syndrome (PVS) presented with a history of progressive dysphagia over six months, not responding to iron therapy and endoscopic dilatations. Her upper gastrointestinal endoscopy showed a post-cricoid web dilated using a Savary-Gilliard dilator. On NBI, a long segment circumferential lesion with abnormal microvascular architecture was noted in the mid esophagus. Biopsy showed high-grade dysplastic squamous epithelium. The patient underwent minimally invasive, circumferential endoscopic submucosal dissection (ESD) and received oral prednisolone to prevent stricture formation. Resected margins were free of dysplasia. At follow-up there was no evidence of recurrence or stricture formation. To our knowledge, this is the first case of PVS with squamous proliferation with high-grade dysplasia that was successfully treated with circumferential ESD. Screening endoscopy helps in the downstaging of early cancer, and timely intervention helps to treat this with a minimally invasive approach like ESD.
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Affiliation(s)
- Gaurav Patil
- Baldota Institute of Digestive Sciences, Gleneagles Global Hospital, Mumbai, Maharashtra, India
| | - Amol Vadgaonkar
- Baldota Institute of Digestive Sciences, Gleneagles Global Hospital, Mumbai, Maharashtra, India
| | - Ankit Dalal
- Baldota Institute of Digestive Sciences, Gleneagles Global Hospital, Mumbai, Maharashtra, India
| | - Sanil Parekh
- Baldota Institute of Digestive Sciences, Gleneagles Global Hospital, Mumbai, Maharashtra, India
| | - Animesh Shah
- Baldota Institute of Digestive Sciences, Gleneagles Global Hospital, Mumbai, Maharashtra, India
| | - Poorva Haridas
- Baldota Institute of Digestive Sciences, Gleneagles Global Hospital, Mumbai, Maharashtra, India
| | - Prajakta Gupte
- Department of Pathology, HBT Medical College and Dr. R N Cooper Hospital, Mumbai, Maharashtra, India
| | - Sehajad Vora
- Baldota Institute of Digestive Sciences, Gleneagles Global Hospital, Mumbai, Maharashtra, India
| | - Amit Maydeo
- Baldota Institute of Digestive Sciences, Gleneagles Global Hospital, Mumbai, Maharashtra, India
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Dalal A, Kamat N, Patil G, Daftary R, Maydeo A. Usefulness of endoscopic ultrasound in children with pancreatobiliary and gastrointestinal symptoms. Endosc Int Open 2022; 10:E192-E199. [PMID: 35178337 PMCID: PMC8847054 DOI: 10.1055/a-1675-2291] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2021] [Accepted: 08/23/2021] [Indexed: 11/09/2022] Open
Abstract
Background and study aims Endoscopic ultrasound (EUS) is useful in diagnosing and treating childhood pancreatobiliary and gastrointestinal diseases. However, there are limited data on its effectiveness for various indications. Patients and methods This was a retrospective analysis of prospectively collected data of patients who underwent EUS for upper gastrointestinal tract disorders from January 2018 to December 2020 to assess its indications, findings, interventions, and complications. Results Ninety-two procedures were performed in 85 children, (70.5 % male; mean [SD] age 12.1 years [3.9] years) with a mean (SD) symptom duration of 1.1 (0.5) years. The procedures were technically successful in all patients. The primary indication for EUS was abdominal pain in 45(52.9%) and jaundice/cholangitis in 15 patients (17.6 %). General anesthesia was used in 12 (13 %) and TIVA in 80 patients (87 %). The most common diagnostic findings were choledocholithiasis in 21 (24.7 %) and cholelithiasis in 12 patients (14.1 %). Among interventions, EUS-guided cystogastrostomy for pancreatic pseudocyst was done in four patients (4.7 %), and EUS-guided rendezvous for failed ERCP in one patient (1.2 %) with cholangitis. There were no immediate post-procedural complications. Overall, EUS had a meaningful impact on the subsequent clinical management in 69 cases (81.2 %). Conclusions EUS in the pediatric population is safe, effective, and has a meaningful impact in appropriately selected cases. It can act as a rescue in major therapeutic procedures, but adequate care should be taken at the procedural level and during anesthesia.
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Affiliation(s)
- Ankit Dalal
- Baldota Institute of Digestive Sciences, Gleneagles Global Hospital, Mumbai, Maharashtra, India
| | - Nagesh Kamat
- Baldota Institute of Digestive Sciences, Gleneagles Global Hospital, Mumbai, Maharashtra, India
| | - Gaurav Patil
- Baldota Institute of Digestive Sciences, Gleneagles Global Hospital, Mumbai, Maharashtra, India
| | - Rajen Daftary
- Baldota Institute of Digestive Sciences, Gleneagles Global Hospital, Mumbai, Maharashtra, India
| | - Amit Maydeo
- Baldota Institute of Digestive Sciences, Gleneagles Global Hospital, Mumbai, Maharashtra, India
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Dalal A, Gandhi C, Patil G, Kamat N, Vora S, Maydeo A. Safety and efficacy of different techniques in difficult biliary cannulation at endoscopic retrograde cholangiopancreatography. Hosp Pract (1995) 2022; 50:61-67. [PMID: 35025705 DOI: 10.1080/21548331.2022.2029451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Adverse events (AEs) are commonly seen at endoscopic retrograde cholangiopancreatography (ERCP) during difficult biliary cannulation (DBC). Therefore, attaining the right technique is essential to have improved outcomes. METHODS Patients who had DBC over a 3-year period were assessed for outcomes. The protocol included double guidewire (DGW) technique, wire-guided cannulation (WGC) after pancreatic stent, precut sphincterotomy/fistulotomy, and EUS-guided rendezvous (RV). The success of various techniques and AE was studied. RESULTS As per available case analysis, a total of 3680 patient details were assessed out of which DBC was noted in 471 (12.8%) patients with a mean (SD) age of 51.5 (17.4) years; majority being 330 (70.1%) males. Most patients underwent precut sphincterotomy 230 (48.8%); however, it was not successful in the first attempt in 10 (2.1%) patients with the success rate of 220 (95.6%). The success rate of DGW cannulation was 120 (95.2%), WGC after pancreatic stent was 64 (94.1%), EUS-RV was 34 (97.1%), and wire-guided repeat ERCP after 48 h was 10 (98.3%). AEs were noted in 52 (11.1%) patients. After precut, 32 (13.9%) patients developed AE out of which post-ERCP pancreatitis was noted in 20 (8.7%). Twenty-three patients had failed biliary access after all methods and 20 (86.9%) of those received successful percutaneous transhepatic biliary drainage. CONCLUSION Repeat ERCP after 48 h and EUS-RV appear prudent for DBC. Precut remains one of the preferred choices for most endoscopists when there is no entrance to PD. Further utilizing an algorithmic approach can contribute to higher success rates without compromising safety.
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Affiliation(s)
- Ankit Dalal
- Baldota Institute of Digestive Sciences, Gleneagles Global Hospital, Mumbai, India
| | - Chaiti Gandhi
- Baldota Institute of Digestive Sciences, Gleneagles Global Hospital, Mumbai, India
| | - Gaurav Patil
- Baldota Institute of Digestive Sciences, Gleneagles Global Hospital, Mumbai, India
| | - Nagesh Kamat
- Baldota Institute of Digestive Sciences, Gleneagles Global Hospital, Mumbai, India
| | - Sehajad Vora
- Baldota Institute of Digestive Sciences, Gleneagles Global Hospital, Mumbai, India
| | - Amit Maydeo
- Baldota Institute of Digestive Sciences, Gleneagles Global Hospital, Mumbai, India
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Maydeo A, Thakare S, Vadgaonkar A, Patil G, Dalal A, Kamat N, Vora S. Impact of Mobile Endoscopy Unit for Rendering Gastrointestinal Endoscopy Services at Two Community Health Centers in Western India. Journal of Digestive Endoscopy 2022. [DOI: 10.1055/s-0041-1741387] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Abstract
Background Patients with gastrointestinal (GI) symptoms in remote areas do not have access to standard medical care with the issues related to cost of medical care, transportation, health literacy, lack of healthcare insurance—all preventing healthcare access in a timely manner. To overcome this, we designed a mobile endoscopy van with the intent to provide free essential medical services to the rural population.
Methods This is a retrospective study of patients with predominantly upper GI symptoms at two community health centers (each 2 days camp). This is an audit of endoscopy findings in a community set up using a Mobile Endoscopy Unit (MEU). Patients' details were collected in a pre-designed questionnaire. Only those patients with alarm symptoms and suspicion of any pathological state underwent esophagogastroduodenoscopy (EGD) in MEU. Data analysis was done using descriptive statistics.
Results A total of 724 patients (424 [58.5%] males; mean [SD] age 48.5 [5.2] years) were included. The commonest presenting symptom was heartburn in 377 (52.1%) patients. The median duration of symptoms was 6.5 (range: 2–36) months. Gastroesophageal reflux disease was seen in 16 (6.8%) patients, ulceroproliferative growth was noted in the stomach in 3 (1.3%) patients. Eighteen (7.6%) patients had a positive rapid urease test and received Helicobacter pylori eradication therapy. The most commonly prescribed drugs were proton-pump inhibitors in 692 (95.6%) patients. Nine (1.2%) patients had chronic liver disease secondary to alcoholism and were counseled for abstinence. All procedures were safely performed without any immediate adverse events.
Conclusions Community outreach strategies such as the use of mobile endoscopy unit were found to be very useful in the diagnosis of GI symptoms. More research is needed in low-income countries to treat complex pathological states in rural patients.
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Affiliation(s)
- Amit Maydeo
- Baldota Institute of Digestive Sciences, Gleneagles Global Hospital, Mumbai, Maharashtra, India
| | - Shivaji Thakare
- Baldota Institute of Digestive Sciences, Gleneagles Global Hospital, Mumbai, Maharashtra, India
| | - Amol Vadgaonkar
- Baldota Institute of Digestive Sciences, Gleneagles Global Hospital, Mumbai, Maharashtra, India
| | - Gaurav Patil
- Baldota Institute of Digestive Sciences, Gleneagles Global Hospital, Mumbai, Maharashtra, India
| | - Ankit Dalal
- Baldota Institute of Digestive Sciences, Gleneagles Global Hospital, Mumbai, Maharashtra, India
| | - Nagesh Kamat
- Baldota Institute of Digestive Sciences, Gleneagles Global Hospital, Mumbai, Maharashtra, India
| | - Sehajad Vora
- Baldota Institute of Digestive Sciences, Gleneagles Global Hospital, Mumbai, Maharashtra, India
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Patil G, Maydeo A, Dalal A, Iyer A, More R, Thakare S. Endoscopic Retroperitoneal Necrosectomy for Infected Pancreatic Necrosis Using a Self-Expandable Metal Stent. GE Port J Gastroenterol 2021; 28:425-430. [PMID: 34901451 DOI: 10.1159/000510025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/21/2020] [Accepted: 06/22/2020] [Indexed: 12/11/2022]
Abstract
Infected walled-off pancreatic necrosis (WOPN) is a severe complication of acute pancreatitis. Surgery in these critically ill patients can be associated with increased morbidity and mortality. Hence, minimally invasive therapies have emerged as an alternative to surgery. Herein, we report a case of severe acute pancreatitis with WOPN which was treated percutaneously with a flexible endoscope through an esophageal self-expanding metal stent using a total retroperitoneal approach. Percutaneous direct endoscopic necrosectomy (p-DEN) using the retroperitoneal route improved the patient's parameters dramatically with resolution of sepsis without the need for surgery. p-DEN using a flexible endoscope passed through a large bore metal stent shows promise in selected patients with WOPN and can be used in patients who are not ideal candidates for transmural or surgical drainage.
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Affiliation(s)
- Gaurav Patil
- Baldota Institute of Digestive Sciences, Gleneagles Global Hospital, Mumbai, India
| | - Amit Maydeo
- Baldota Institute of Digestive Sciences, Gleneagles Global Hospital, Mumbai, India
| | - Ankit Dalal
- Baldota Institute of Digestive Sciences, Gleneagles Global Hospital, Mumbai, India
| | - Arun Iyer
- Baldota Institute of Digestive Sciences, Gleneagles Global Hospital, Mumbai, India
| | - Rajdeep More
- Baldota Institute of Digestive Sciences, Gleneagles Global Hospital, Mumbai, India
| | - Shivaji Thakare
- Baldota Institute of Digestive Sciences, Gleneagles Global Hospital, Mumbai, India
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Ramchandani JP, Gupta A, Goh M, Dalal A. Kikuchi-Fujimoto disease: a rare cause of histiocytic necrotising lymphadenitis in young ethnic women. Ann R Coll Surg Engl 2021; 104:e79-e80. [PMID: 34812682 DOI: 10.1308/rcsann.2021.0116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Kikuchi-Fujimoto is a rare but self-limiting disease usually affecting young ethnic females. The main clinical presentation is fever and cervical lymphadenopathy. Here we describe the cases of two patients with cervical lymphadenopathy, fever and fatigue. In addition, patients can present with neutropenia; hence, early diagnosis is crucial to exclude a malignant cause.
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Affiliation(s)
| | - A Gupta
- King's College London Medical School, UK
| | - M Goh
- OMFS Department, Poole Hospital, UK
| | - A Dalal
- OMFS Department, Poole Hospital, UK
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Dalal A, Patil G, Kamat N, Daftary R, Vora S, Maydeo A. Utility of the Novel SpyGlass<sup>TM</sup> DS II System and Laser Lithotripsy for Choledocholithiasis in Pregnancy. GE Port J Gastroenterol 2021; 29:172-177. [DOI: 10.1159/000517979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Accepted: 05/12/2021] [Indexed: 11/19/2022]
Abstract
<b><i>Background and Aim:</i></b> Endoscopic retrograde cholangiopancreatography (ERCP) is considered a safe therapeutic modality even in pregnant women; however, adequate care needs to be taken. The utility of the SpyGlass<sup>TM</sup> DS II system in choledocholithiasis among pregnant women is unexplored. <b><i>Methods:</i></b> We retrospectively analyzed patients who underwent<b><i></i></b>ERCP for choledocholithiasis in the absence of fluoroscopy using the SpyGlass DS II system from October 2019 to November 2020. Depending on the size and location of the stones, we used laser lithotripsy (LL) for large impacted stones, the balloon extraction technique for multiple stones, and the SpyGlass retrieval basket for single solitary stones. <b><i>Results:</i></b> A total of 10 (100% female) patients with a mean (±SD) age of 29.5 (±2.5) years underwent ERCP. Abdominal pain was the commonest presenting symptom in all patients. Four (40%) patients had cholangitis and 3 (30%) had pancreatitis. The majority of the patients (9; 90%) were in the second trimester. MRCP was the commonest radiological entity, used in 9 (90%) patients. ERCP was technically successful and the stones were removed from all of the patients in a mean (±SD) time of 30 (±3.5) min. LL was used successfully in 4 (40%) patients, balloon extraction in 3 (30%) patients, and the SpyGlass retrieval basket in 3 (30%) patients. There were no pre- or post-procedural complications. All of the patients had an uneventful childbirth, after which they underwent cholecystectomy and subsequent stent removal 2 weeks later. <b><i>Conclusions:</i></b> Use of the SpyGlass DS II system and LL during ERCP appears safe and effective for the treatment of choledocholithiasis among pregnant women.
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Jakhar D, Das A, Kaul S, Kaur I, Madke B, Dalal A. Prevalence and characteristics of dermatological manifestations in COVID-19 positive dermatologists: Report from a web-based survey in India. J Eur Acad Dermatol Venereol 2021; 35:e832-e833. [PMID: 34297886 PMCID: PMC8447020 DOI: 10.1111/jdv.17532] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 06/07/2021] [Accepted: 07/06/2021] [Indexed: 01/08/2023]
Affiliation(s)
- D Jakhar
- Dermosphere clinic, New Delhi, India
| | - A Das
- Department of Dermatology, KPC Medical College & Hospital, Kolkata, India
| | - S Kaul
- Department of Internal Medicine, John H Stroger Hospital of Cook county, Chicago, USA
| | - I Kaur
- Department of Dermatology, North Delhi Municipal Corporation Medical College & Hindu Rao Hospital, New Delhi, India
| | - B Madke
- Department of Dermatology, Venereology and Leprology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical Sciences, Sawangi Meghe, Wardha, Maharashtra, India
| | - A Dalal
- Department of Dermatology, Saheed Hasan Khan Mewati Government Medical College and Hospital, Nuh, India
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19
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Patil G, Dalal A, Maydeo A. Early outcomes of peroral endoscopic myotomy with fundoplication for achalasia cardia - Is it here to stay? Dig Endosc 2021; 33:561-568. [PMID: 32691889 DOI: 10.1111/den.13796] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Revised: 07/13/2020] [Accepted: 07/14/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND Peroral endoscopic myotomy with fundoplication (POEM-F) has garnered widespread attention since it tries to achieve an appropriate antireflux procedure during the same setting. The outcomes of POEM-F are currently unexplored. METHODS Patients who underwent POEM-F at our center were retrospectively studied to assess its safety and early outcomes. RESULTS Twenty patients [70% male; median age 32 years (range 25-41)], with a median symptom duration of 2.1 years (range 1.5-3.7) with achalasia were included. POEM-F procedure was completed in a median of 118 min (range 90-160), with 17/20 (85%) technical success. The median hospitalization was 4 days (range 2-7). Capnothorax (n = 3), resolved spontaneously (n = 2) in 4-6 h, while in one patient (n = 1) the endoscope inadvertently entered into the thoracic cavity for which prophylactic intercostal drain was required. Capnoperitoneum was seen in 17/17 (100%) patients who underwent fundoplication, subcutaneous emphysema in 8/17 (47%) patients. At 1-month follow-up endoscopy, 5/17 (29.4%) patients had loosening of the fundal wrap, 3/17 (17.6%) patients had ulceration in fundus and in gastroesophageal junction due to underlying hemoclips. At 3 months, loosening of the fundal wrap was seen in 7/17 (41.2%) patients. A 24-h pH-metry revealed abnormal esophageal acid exposure in 7/17 (41.2%) patients, while it was normal in those patients in whom the fundal wrap was maintained. 10/17 (58.8%) patients were off proton pump inhibitors. CONCLUSION POEM-F is technically feasible with reasonable short term success. However, the durability, early success and safety of POEM-F need reassessment in long-term studies before being applied in clinical practice.
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Affiliation(s)
- Gaurav Patil
- Baldota Institute of Digestive Sciences, Gleneagles Global Hospital, Mumbai, India
| | - Ankit Dalal
- Baldota Institute of Digestive Sciences, Gleneagles Global Hospital, Mumbai, India
| | - Amit Maydeo
- Baldota Institute of Digestive Sciences, Gleneagles Global Hospital, Mumbai, India
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Brennan PA, Dalal A, Knighton J, Jones R, Oeppen RS. Pilot study to evaluate safety culture perception in the operating theatres of an acute NHS Trust using the National Air Traffic Services (NATS) App. Br J Oral Maxillofac Surg 2021; 59:1085-1089. [PMID: 34281735 DOI: 10.1016/j.bjoms.2021.04.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Accepted: 04/15/2021] [Indexed: 11/19/2022]
Abstract
An area critical to safety in an organisation is the perceived and actual culture. National Air Traffic Services (NATS) work closely with large safety-critical industries including various aviation companies to enable them to identify strengths and vulnerabilities with the aim of improving safe practice. NATS have developed a simple free downloadable self-assessment App that individuals can use to assess their own culture perception in their organisation. The App has 16 questions arranged in four domains but to our knowledge it has not been used to date in healthcare. As part of the initiatives to improve staff culture, we evaluated operating theatre colleagues' safety perception in our large acute NHS Trust in a pilot study using the NATS safety App. Staff downloaded the App to their smart device before completing it. Responses were sent anonymously through the App and collated by NATS. A total of 146 colleagues downloaded and completed the questionnaire. One hundred and seventeen staff (80%) felt encouraged to report safety concerns, but 86% (n=126) confirmed a lack of available support from healthcare managers. Only 43% of respondents (n=63) would find it easy to challenge colleagues if they observed unsafe behaviour. This pilot study has identified positive indicators of an evolving NHS safety culture, and some concerns about speaking up, support, and challenging colleagues without fear. These issues are known to occur across healthcare. Further work is needed in the NHS to provide a supportive environment to improve patient safety, and lower hierarchy in surgical teams.
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Affiliation(s)
- P A Brennan
- Maxillofacial Unit, Queen Alexandra Hospital, Portsmouth PO6 3LY, UK.
| | - A Dalal
- Poole Hospital, Longfleet Road, Poole BH15 2JB, UK
| | - J Knighton
- Queen Alexandra Hospital, Portsmouth PO6 3LY, UK
| | - R Jones
- Queen Alexandra Hospital, Portsmouth PO6 3LY, UK
| | - R S Oeppen
- Southampton University Hospitals Trust, Tremona Road, Southampton SO16 6YD, UK
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Patil G, Iyer A, Dalal A, Maydeo A. The Usefulness of an Endoscopic OverStitch Suturing System for Managing Anastomotic Dehiscence - A Case Report. GE Port J Gastroenterol 2020; 27:434-438. [PMID: 33251293 DOI: 10.1159/000507224] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/15/2019] [Accepted: 02/22/2020] [Indexed: 12/15/2022]
Abstract
Anastomotic dehiscence (AD) after colorectal surgery contributes to poor outcomes resulting in multiple postoperative complications. Conventional management would be a repeat laparotomy and tension suturing. But owing to the unhealthy vicinities near the suture lines, there is a significant risk of technical failure which further increases postoperative morbidity and mortality. A 60-year-old male, with a history of hypertension, ischemic heart disease, and previous percutaneous transluminal coronary angioplasty, underwent sigmoid colectomy with colorectal anastomosis for complicated sigmoid diverticulitis. He then developed anastomotic site leak for which an ileostomy was done. Prior to the ileostomy revision, he was referred for colonoscopic evaluation which showed the persistence of a partial AD. We decided to close the defect endoscopically with the Apollo OverStitch device. Initial tissue preparation was done by creating a surgical surface using argon plasma coagulation at the perimeter of the leak site. A double channel therapeutic endoscope with the OverStitch assembly was passed to take full-thickness running sutures across the rent to facilitate full closure. The area examined showed good suture approximation and complete closure. The procedure was successful with no immediate or delayed postprocedural complications. Repeat endoscopic evaluation at about two weeks showed well-approximated edges with intact suture lines, and there was complete resolution of the leak. The patient subsequently underwent revision surgery after a month. The patient is under close follow-up and doing well. The Apollo OverStitch device has certainly opened new avenues in flexible endoscopic surgery which need further exploratory studies to add to existing promising results.
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Affiliation(s)
- Gaurav Patil
- Baldota Institute of Digestive Sciences, Global Hospitals, Mumbai, India
| | - Arun Iyer
- Baldota Institute of Digestive Sciences, Global Hospitals, Mumbai, India
| | - Ankit Dalal
- Baldota Institute of Digestive Sciences, Global Hospitals, Mumbai, India
| | - Amit Maydeo
- Baldota Institute of Digestive Sciences, Global Hospitals, Mumbai, India
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Patil G, Iyer A, Dalal A, Maydeo A. A novel technique to treat dysphagia after endoscopic full-thickness plication for managing gastroesophageal reflux disease. Turk J Gastroenterol 2020; 31:671-672. [PMID: 33090105 DOI: 10.5152/tjg.2020.19714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- Gaurav Patil
- Baldota Institute of Digestive Sciences, Gleneagles Global Hospitals, Mumbai, Maharashtra, India
| | - Arun Iyer
- Baldota Institute of Digestive Sciences, Gleneagles Global Hospital, Mumbai, Maharashtra, India
| | - Ankit Dalal
- Baldota Institute of Digestive Sciences, Gleneagles Global Hospital, Mumbai, Maharashtra, India
| | - Amit Maydeo
- Baldota Institute of Digestive Sciences, Gleneagles Global Hospital, Mumbai, Maharashtra, India
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Affiliation(s)
- Gaurav Patil
- Baldota Institute of Digestive Sciences, Gleneagles Global Hospitals, Mumbai, Maharashtra, India
| | - Arun Iyer
- Baldota Institute of Digestive Sciences, Gleneagles Global Hospitals, Mumbai, Maharashtra, India
| | - Amol Vadgaonkar
- Baldota Institute of Digestive Sciences, Gleneagles Global Hospitals, Mumbai, Maharashtra, India
| | - Ankit Dalal
- Baldota Institute of Digestive Sciences, Gleneagles Global Hospitals, Mumbai, Maharashtra, India
| | - Amit Maydeo
- Baldota Institute of Digestive Sciences, Gleneagles Global Hospitals, Mumbai, Maharashtra, India
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Maydeo A, Patil G, Dalal A, Thakare S, Iyer A, Patil N. An Indian Experience of Endoscopic Treatment of Obesity by Using a Novel Technique of Endoscopic Sleeve Gastroplasty (Accordion Procedure). J Assoc Physicians India 2020; 68:14-17. [PMID: 32738834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
INTRODUCTION Endoscopic Sleeve gastroplasty (ESG) is a novel minimally invasive endoscopic restrictive bariatric procedure. We studied the safety, effectiveness, 6-month weight loss outcomes of ESG. METHODS We prospectively collected data for patients undergoing ESG at a tertiary care referral center. Laboratory investigations were performed preoperatively, and at 6 months post-operatively. Anthropometric measurements were noted pre and post-operatively at a frequency of 3 months for a 6-month follow-up. Patients with BMI ≥28 kg/m2 who were ready for multidisciplinary follow up for at least 6 months were part of the study. Weight was evaluated at 1, 3 and 6 months' post procedure, and percent of total weight loss (%TWL) and percent of extra weight loss (% EWL) was calculated. Adverse events and new-onset symptoms were recorded. RESULTS This prospective study included 58 patients, [55(94.8%)females] who underwent ESG (Jun 2018 - July 2019) using the Over Stitch device (Apollo Endosurgery, Inc., Austin, Texas, US). Mean age was 42.1 years (range 23-53) and mean BMI (kg/m2) was 37.88 (range 28.4-42.9). A median of 5 plications (range 4-6) were used to provide a tubular restriction to the gastric cavity. Mean procedural time (min) was 55 (Range 45 - 86). The mean (±SD) weight reduced significantly from baseline of 98.3±20.4 to 81.8±19.1 at 6 months (p<0.001). The mean BMI reduced significantly from baseline of 37.88±5.76 to 31.37±5.23 at 6months (p<0.001). The mean % of TWL was 8.8 (5.6-16.1), 12.6(10.4-19.1) and 17.1 (11.2-24.1) at 1, 3 and 6 months respectively. The % of EWL was 21.3(12.3-34.3), 30.5(17.7-45.6) and 42.8 (24.5-61.9) at 1, 3 and 6 months respectively. No major complications developed, and patients were discharged on postoperative day 2 (+4 days). Nausea 29 (50%) and moderate to severe abdominal pain 14 (24.1%) were the most common adverse events, treated conservatively. Stitch loosening was noted in 1(1.7%) patient at third month who underwent resuturing. CONCLUSIONS ESG appears safe and effective in treating obesity at our center. Mindfulness to reduction in %TWL, %EWL and BMI are critical in evaluating the initial success of ESG. Long term follow-up is required to assess for its sustained effect. Further research into dietary and behavioral modifications with ESG is warranted.
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Affiliation(s)
- Amit Maydeo
- Director, Baldota Institute of Digestive Sciences, Mumbai, Maharashtra
| | - Gaurav Patil
- Consultant, Baldota Institute of Digestive Sciences, Mumbai, Maharashtra
| | - Ankit Dalal
- Consultant, Baldota Institute of Digestive Sciences, Mumbai, Maharashtra
| | - Shivaji Thakare
- Senior Resident, Baldota Institute of Digestive Sciences, Mumbai, Maharashtra
| | - Arun Iyer
- Consultant, Baldota Institute of Digestive Sciences, Mumbai, Maharashtra
| | - Nikhil Patil
- Consultant, Baldota Institute of Digestive Sciences, Mumbai, Maharashtra
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Abstract
Abstract
Background The commonest therapeutic indications for double balloon enteroscopy (DBE) includes removal of retained video capsules, dilatation of strictures, polypectomy, and managing obscure small bowel bleeding. We review our experience in managing active small bowel bleeding with DBE.
Methods A retrospective review was done for all the cases undergoing DBE from August 2017 to July 2019. Patient follow-up data was collected.
Results Among 25 cases with a median age of 46.8 (range 25–65 years), 17 males (68%) underwent DBE for suspected small bowel bleeding. The commonest presenting complaint was melena 19 (76%). The findings were positive (diagnostic yield) in 18 (72%) patients with an antegrade approach. Active bleeding was associated with Dieulafoy's lesion (n = 6), gastrointestinal stromal tumors (GIST) (n = 4), jejunal varices (n = 3), angioectasia (n = 3), and ulcer (n = 2), who then underwent successful intervention. The rest of the patients underwent both antegrade and retrograde approach but failed to immediately identify an alternative diagnosis. Mean (standard deviation [SD]) time taken for antegrade enteroscopy was 96.7 (15.3) mins and 67.8 (13.6) mins for retrograde enteroscopy. The median duration between the last bleeding episode and timing of DBE was 9 (range 6–15 hours). No major complications were seen during or immediately postprocedure.
Conclusion DBE is useful in identifying and treating active small bowel bleeding. Being invasive and time-intensive, it is easy to miss lesions and, therefore, needs appropriate expertise. DBE does appear to be relatively cheaper, with better patient acceptance and time saving.
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Affiliation(s)
- Ankit Dalal
- Baldota Institute of Digestive Sciences, Gleneagles Global Hospital, Mumbai, Maharashtra, India
| | - Gaurav Patil
- Baldota Institute of Digestive Sciences, Gleneagles Global Hospital, Mumbai, Maharashtra, India
| | - Amit Maydeo
- Baldota Institute of Digestive Sciences, Gleneagles Global Hospital, Mumbai, Maharashtra, India
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Patil G, Dalal A, Maydeo A. Feasibility and outcomes of anti-reflux mucosectomy for proton pump inhibitor dependent gastroesophageal reflux disease: First Indian study (with video). Dig Endosc 2020; 32:745-752. [PMID: 31834663 DOI: 10.1111/den.13606] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Accepted: 12/10/2019] [Indexed: 02/08/2023]
Abstract
BACKGROUND Anti-reflux mucosectomy (ARMS) is a newfangled minimally invasive technique, with successful outcomes for the management of gastroesophageal reflux (GER). We present our initial experience (success rate) and safety profile for this procedure. METHODS Consecutive patients with daily dependence on proton pump inhibitor (PPI) for GER were prospectively enrolled from September 2016 to August 2019 and underwent ARMS using a cap assisted endoscopic mucosal resection. Severity was assessed by gastroesophageal reflux disease questionnaire. Gastroscopy and 24-h pH-metry was done pre and post procedure. Patient characteristics, PPI requirement, adverse events and follow-up were documented. RESULTS Sixty-two patients [44 (71%) male] underwent successful ARMS with a mean age (SD) of 36 (9.9) years. Technical success was achieved in 100 % of patients. Intraoperative bleeding was noted in 62 (100%) patients, endoscopic hemostasis was successfully achieved. At follow-up dysphagia was seen in 5 (8%) patients which needed a single session of endoscopic dilation. At 2 months, mean (SD) DeMeester score normalized in 45 (72.5%) patients from 76.8 (18.3) to 14.3 (6.1) (P < 0.001). PPI could be stopped in 43 (69.4%) patients. The mean (SD) GERD-Q score reduced from 10.6 (1.9) to 3.4 (1.5) (P < 0.001). However, in 12 (19.3%) patients low dose of PPIs was continued, while 7 (11.3%) patients continued full dose. Thirty-eight (61.3%) patients telephonically reported symptomatic improvement and were off PPIs at 12 months. CONCLUSIONS Anti-reflux mucosectomy is safe and effective for treatment of GER. The long term outcomes are favorable, response is durable and promising at our center. Appropriate patient selection still remains primal to the overall success of ARMS.
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Affiliation(s)
- Gaurav Patil
- Baldota Institute of Digestive Sciences, Gleneagles Global Hospital, Mumbai, India
| | - Ankit Dalal
- Baldota Institute of Digestive Sciences, Gleneagles Global Hospital, Mumbai, India
| | - Amit Maydeo
- Baldota Institute of Digestive Sciences, Gleneagles Global Hospital, Mumbai, India
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27
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Dalal A, Maydeo A, Pargewar S. Unusual cause of anemia postendoscopic full-thickness plication in a 28-year-old Asian male. Dig Endosc 2020; 32:630. [PMID: 31957139 DOI: 10.1111/den.13628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Affiliation(s)
- Ankit Dalal
- Baldota Institute of Digestive Sciences, Gleneagles Global Hospital, Mumbai, India
| | - Amit Maydeo
- Baldota Institute of Digestive Sciences, Gleneagles Global Hospital, Mumbai, India
| | - Sudheer Pargewar
- Department of Diagnostic and Interventional Radiology, Gleneagles Global Hospital, Mumbai, India
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28
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Dalal A, Patil G, Maydeo A. Six-year retrospective analysis of endoscopic ultrasonography-guided pancreatic ductal interventions at a tertiary referral center. Dig Endosc 2020; 32:409-416. [PMID: 31385380 DOI: 10.1111/den.13504] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Accepted: 07/31/2019] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIM Endoscopic ultrasonography-guided pancreatic ductal intervention (EUS-PDI) serves as a rescue therapy in patients with failure of retrograde access to the pancreatic duct (PD) at the time of endoscopic retrograde pancreatography (ERP). We review our experience of this procedure. METHODS This is a retrospective study of patients who underwent EUS-PDI for an unsuccessful ERP and altered anatomy. RESULTS A total of 44 (65.9% male) patients underwent EUS-PDI with a mean age of 43.5 years, (range: 23-67). Transgastric rendezvous technique was carried out in 23/44 (52.3%), transgastric pancreaticogastrostomy in 18/44 (40.9%) and transduodenal pancreaticobulbostomy in 3/44 (6.8%). Overall technical and clinical success was seen in 88.6% (39/44) and 81.8% (36/44), respectively. Technical success of transgastric rendezvous was 95.6% and that of transgastric pancreaticogastrostomy was 77.8%. Two of seven patients with failure to access the PD had successfully undergone EUS-PD stenting at subsequent attempt. Ten immediate adverse events (AE) were noted which included abdominal pain (n = 4), pancreatitis (n = 2), fever (n = 2), minor bleeding (n = 1), and stripping of wire (n = 1). Delayed AE included stent blockage in 12/39 (30.8%) and spontaneous stent migration in 5/39 (12.8%) which were managed with stent exchange at follow up. The rendezvous technique was associated with fewer AE than transgastric pancreaticogastrostomy. CONCLUSIONS Endoscopic ultrasonography-PDI is an effective treatment modality and salvage therapy in patients with unsuccessful ERP. Technical and clinical success seen with this study is comparable to studies conducted across the world. EUS-PDI needs to show cost-effectiveness in future studies.
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Affiliation(s)
- Ankit Dalal
- Baldota Institute of Digestive Sciences, Global Hospital, Mumbai, India
| | - Gaurav Patil
- Baldota Institute of Digestive Sciences, Global Hospital, Mumbai, India
| | - Amit Maydeo
- Baldota Institute of Digestive Sciences, Global Hospital, Mumbai, India
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Dalal A, Patil G, Maydeo A. Managing an unusual complication of misplaced biliary self-expandable metallic stent after endoscopic retrograde cholangiopancreatography. Dig Endosc 2020; 32:152. [PMID: 31698501 DOI: 10.1111/den.13569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Affiliation(s)
- Ankit Dalal
- Baldota Institute of Digestive Sciences, Gleneagles Global Hospital, Mumbai, India
| | - Gaurav Patil
- Baldota Institute of Digestive Sciences, Gleneagles Global Hospital, Mumbai, India
| | - Amit Maydeo
- Baldota Institute of Digestive Sciences, Gleneagles Global Hospital, Mumbai, India
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Maydeo A, Patil GK, Dalal A. Operative technical tricks and 12-month outcomes of diverticular peroral endoscopic myotomy (D-POEM) in patients with symptomatic esophageal diverticula. Endoscopy 2019; 51:1136-1140. [PMID: 31614371 DOI: 10.1055/a-1015-0214] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Submucosal tunneling diverticular septotomy by diverticular peroral endoscopic myotomy (D-POEM) has emerged as an alternative to surgery for symptomatic esophageal diverticula, but its medium to long-term outcomes are currently unexplored. METHODS D-POEM for patients with symptomatic esophageal diverticula was prospectively studied to assess its safety and the 12-month outcomes. RESULTS 25 patients (72 % male; median age 61 years [range 48 - 88]) with a Zenker's diverticulum (n = 20) or epiphrenic diverticulum (n = 5) were included. Major indications were dysphagia, recurrent bronchoaspiration, and foreign body sensation in 20 patients (80 %), with a mean symptom duration of 2.5 years (range 1 - : 4). Complete submucosal tunneling septotomy was achieved in a mean of 36 minutes (range 25 - : 45), with 100 % technical success. The median hospitalization was 5 days (range 4 - : 10). The mean (standard deviation) Eckardt Score improved significantly from 13.2 (1.0) at baseline to 3.2 (1.4) at 12 months (P < 0.001) with clinical success in 19/22 patients (86 %) and no long-term adverse events. CONCLUSIONS D-POEM appears safe and durable in patients with esophageal diverticula. Further multicenter studies with a larger patient cohort are warranted.
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Affiliation(s)
- Amit Maydeo
- Baldota Institute of Digestive Sciences, Global Hospitals, Mumbai, Maharashtra, India
| | - Gaurav K Patil
- Baldota Institute of Digestive Sciences, Global Hospitals, Mumbai, Maharashtra, India
| | - Ankit Dalal
- Baldota Institute of Digestive Sciences, Global Hospitals, Mumbai, Maharashtra, India
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Abstract
Laparoscopic sleeve gastrectomy (LSG) is an effective treatment modality for obesity. Commonest delayed complication post LSG is gastroesophageal reflux disease (GER). The prevalence of GER among obese patients is higher than normal individuals. Such patients need long term Proton pump inhibitors (PPI) or antireflux procedures to manage reflux. Antireflux mucosectomy (ARMS) uses techniques of endoscopic mucosal resection to treat reflux for PPI refractory GER. However, it can be technically challenging to perform ARMS with a restricted stomach in patients who have undergone LSG. A 40-year-old female, hypertensive who had previously undergone LSG was treated for GER by a multidimensional approach with ARMS utilizing hypotensive anesthesia. The patient underwent the procedure successfully without any complication. She was discharged and at follow up visit, her reflux symptoms had improved and endoscopy was unremarkable. We describe this unusual case which was treated effectively with ARMS.
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Affiliation(s)
- Gaurav Patil
- Baldota Institute of Digestive Sciences, Gleneagles Global Hospital, Mumbai, Maharashtra, India
| | - Arun Iyer
- Baldota Institute of Digestive Sciences, Gleneagles Global Hospital, Mumbai, Maharashtra, India
| | - Ankit Dalal
- Baldota Institute of Digestive Sciences, Gleneagles Global Hospital, Mumbai, Maharashtra, India
| | - Amit Maydeo
- Baldota Institute of Digestive Sciences, Gleneagles Global Hospital, Mumbai, Maharashtra, India
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Dalal A, Patil GK, Maydeo AP, Iyer A, Patil N. Basket impaction during the extraction of a pancreatic ductal stone. Indian J Gastroenterol 2019; 38:550-551. [PMID: 31993917 DOI: 10.1007/s12664-019-00997-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Affiliation(s)
- Ankit Dalal
- Baldota Institute of Digestive Sciences, Gleneagles Global Hospital, Mumbai, 400 012, India
| | - Gaurav K Patil
- Baldota Institute of Digestive Sciences, Gleneagles Global Hospital, Mumbai, 400 012, India
| | - Amit P Maydeo
- Baldota Institute of Digestive Sciences, Gleneagles Global Hospital, Mumbai, 400 012, India.
| | - Arun Iyer
- Baldota Institute of Digestive Sciences, Gleneagles Global Hospital, Mumbai, 400 012, India
| | - Nikhil Patil
- Baldota Institute of Digestive Sciences, Gleneagles Global Hospital, Mumbai, 400 012, India
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33
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Dalal A, Patil G, Vadgaonkar A, Maydeo A. A rare case of intraductal tubulopapillary neoplasm of the pancreas - case report (with video). Postgrad Med 2019; 132:270-273. [PMID: 31524017 DOI: 10.1080/00325481.2019.1669058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Intraductal tubulopapillary neoplasm (ITPN) is a premalignant epithelial tumor of the pancreas. We report a case of ITPN detected incidentally during histopathology examination (HPE) from a specimen taken at the time of endosonography in a patient with pancreatitis. A 53-year-old man presented with severe recurrent epigastric pain, associated with episodic nonbilious vomiting, with a weight loss of about 7 Kg since 15 days. He underwent Magnetic resonance cholangiopancreatography which showed an ovoid soft tissue lesion in the Pancreatic duct (PD) reported as possible intraductal neoplasm. Patient underwent Endoscopic Ultrasound, whereby the PD was dilated and a large hypoechoic lesion was noted in the PD (head region) causing upstream dilatation. Lesion did not show any vascularity on Doppler. Fine needle biopsy was sent from the intraductal lesion for histopathology examination (HPE). Patient then underwent an ERCP. After performing a pancreatic sphincterotomy, pancreaticoscopy was done using SPYGLASS DS system which showed a nodular intraluminal lesion in the head region with irregular and abnormal vascularity and papillary fronds. Biopsies were taken from this lesion using SpyBite biopsy forceps. To our surprise this HPE report came out to be ITPN. Patient was then referred for surgery. There is often a difference of opinion in distinguishing and classifying such tumors when compared to the subtypes of mucinous neoplasm. Identification of this neoplasm is often challenging for pathologists as well as radiologists. We present this case since it is infrequent and atypical in routine medical practice.
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Affiliation(s)
- Ankit Dalal
- Baldota Institute of Digestive Sciences, Global Hospitals , Mumbai, India
| | - Gaurav Patil
- Baldota Institute of Digestive Sciences, Global Hospitals , Mumbai, India
| | - Amol Vadgaonkar
- Baldota Institute of Digestive Sciences, Global Hospitals , Mumbai, India
| | - Amit Maydeo
- Baldota Institute of Digestive Sciences, Global Hospitals , Mumbai, India
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34
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Dalal A, Patil GK, Maydeo AP. Endoscopic resection of an unusual ampullary adenoma. VideoGIE 2019; 4:334-336. [PMID: 31334427 PMCID: PMC6617108 DOI: 10.1016/j.vgie.2019.03.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Affiliation(s)
- Ankit Dalal
- Baldota Institute of Digestive Sciences, Global Hospitals, Mumbai, Maharashtra, India
| | - Gaurav K Patil
- Baldota Institute of Digestive Sciences, Global Hospitals, Mumbai, Maharashtra, India
| | - Amit P Maydeo
- Baldota Institute of Digestive Sciences, Global Hospitals, Mumbai, Maharashtra, India
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35
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Dalal A, Ives C. Tape to view: novel technique to improve axillary access. Ann R Coll Surg Engl 2019; 101:617. [PMID: 31232621 DOI: 10.1308/rcsann.2019.0085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- A Dalal
- Breast Unit, Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
| | - C Ives
- Breast Unit, Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
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36
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Sherman S, Amitay-Laish I, Kremer N, Dalal A, Solomon Cohen E, Bercovich E, Noyman Y, Levi A, Pavlovsky L, Prag Naveh H, Hodak E. Mycosis fungoides is associated with melanoma in Israeli patients. Eur J Cancer 2019. [DOI: 10.1016/s0959-8049(19)30535-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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37
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Laxmeshwar C, Stewart AG, Dalal A, Kumar AMV, Kalaiselvi S, Das M, Gawde N, Thi SS, Isaakidis P. Beyond ‘cure' and ‘treatment success': quality of life of patients with multidrug-resistant tuberculosis. Int J Tuberc Lung Dis 2019; 23:73-81. [DOI: 10.5588/ijtld.18.0149] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
| | | | | | - A. M. V. Kumar
- International Union Against Tuberculosis and Lung Disease (The Union), South-East Asia Office, New Delhi, India, The Union, Paris, France
| | - S. Kalaiselvi
- Pondicherry Institute of Medical Sciences, Puducherry
| | - M. Das
- Médecins Sans Frontières (MSF), Mumbai, India
| | - N. Gawde
- Tata Institute of Social Sciences, Mumbai, India
| | - S. S. Thi
- Médecins Sans Frontières (MSF), Mumbai, India
| | - P. Isaakidis
- Médecins Sans Frontières (MSF), Mumbai, India, MSF, Operational Research Unit, Luxembourg City, Luxembourg
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Dhir V, Adler DG, Dalal A, Aherrao N, Shah R, Maydeo A. Early removal of biflanged metal stents in the management of pancreatic walled-off necrosis: a prospective study. Endoscopy 2018; 50:597-605. [PMID: 29272904 DOI: 10.1055/s-0043-123575] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND AND STUDY AIMS Dedicated stents placed under endoscopic ultrasound (EUS) guidance have shown promise for the management of pancreatic walled-off necrosis (WON). A long duration of stent placement may increase the risk of adverse events. We prospectively evaluated the effects of (i) early removal of biflanged metal stents (BFMSs) and (ii) additional stenting of the pancreatic duct with plastic stents in patients with ductal leaks, on the risk of WON recurrence. PATIENTS AND METHODS Symptomatic patients with pancreatic WON underwent EUS-guided BFMS placement, followed by necrosectomy, when required, from Day 3. A 5 Fr plastic stent was placed in patients with ductal leak. BFMS was removed when the WON cavity had collapsed completely. Patients were followed up at 3-month intervals. RESULTS BFMS placement was successful in all 88 patients. A total of 64 patients (72.7 %) underwent necrosectomy (median 3 sessions). All BFMSs were removed at a median of 3.5 weeks (range 3 - 17 weeks). Ductal disconnection and leak occurred in 53/87 (60.9 %) and 61/87 (70.1 %) patients, respectively. A 5 Fr stent was placed in 56/61 patients (91.8 %) with ductal leak. Overall, 22 patients (25.0 %) had adverse events (17 mild, 1 moderate, 3 severe, 1 fatal). Recurrence was noted in 8/88 (9.1 %) at a median follow-up of 22 months. The recurrence rate was higher in patients with ductal disconnection than in those without (13.2 % vs. 2.9 %; P = 0.08), and was similar in patients with vs. without pancreatic duct stenting (7.1 % vs. 12.9 %; P = 0.44). Seven recurrences (87.5 %) partially regressed on follow-up and did not require therapy; in one case, drainage with a plastic stent was performed. CONCLUSIONS Short-term BFMS placement is an effective therapy for pancreatic WON. The majority of recurrences developed in patients with ductal disconnection and did not require therapy. Additional pancreatic duct stents probably do not influence the recurrence rate.
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Affiliation(s)
- Vinay Dhir
- Baldota Institute of Digestive Sciences, Mumbai, India
| | - Douglas G Adler
- University of Utah School of Medicine, Huntsman Cancer Institute, Salt Lake City, Utah, United States
| | - Ankit Dalal
- Baldota Institute of Digestive Sciences, Mumbai, India
| | - Nitin Aherrao
- Baldota Institute of Digestive Sciences, Mumbai, India
| | - Rahul Shah
- Baldota Institute of Digestive Sciences, Mumbai, India
| | - Amit Maydeo
- Baldota Institute of Digestive Sciences, Mumbai, India
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Shetty T, Nguyen J, Sasaki M, Wu A, Bogner E, Burge A, Cogsil T, Dalal A, Halvorsen K, Cummings K, Su E, Lyman S. Risk factors for nerve injury after total knee arthroplasty: a case control study. Neuromuscul Disord 2018. [DOI: 10.1016/s0960-8966(18)30360-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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40
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Dalal A, Liendo C, Chernyshev O, Hinds E, Minto L. 1236 A Case of Wildervanck Syndrome Likely Predisposing to Obstructive Sleep Apnea With Successful Treatment with Positive Airway Pressure. Sleep 2017. [DOI: 10.1093/sleepj/zsx052.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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41
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Minto L, Dalal A, Liendo C, Hinds E, Chernyshev O. 1237 CSA with Cheyne-Stokes Respiration in Congestive Heart Failure: Treatment with BIPAP-ST utilizing a narrow pressure support. Sleep 2017. [DOI: 10.1093/sleepj/zsx052.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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42
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Minto M, Liendo C, Hinds E, Dalal A, Chernyshev O. 1238 West Nile Encephalitis with suspected diaphragmatic dysfunction leading to sleep apnea with associated hypoventilation. Sleep 2017. [DOI: 10.1093/sleepj/zsx052.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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43
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Dalal A, Liendo C, Hinds E, Minto L, Chernyshev O, Rey de Castro J, Liendo A, Chesson A. 1235 Complex Sleep Apnea Refractory to Positive Airway Pressure (PAP) Therapy While on Baclofen that Responded to Continuous Positive Airway Pressure (CPAP) Therapy upon Cessation of Baclofen. Sleep 2017. [DOI: 10.1093/sleepj/zsx052.025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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44
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Nguyen J, Su E, Lyman S, Manning E, Cummings K, Wu A, Sasaki M, Dalal A, Ching C, Shetty T. Incidence and risk factors for neuropathy following primary total knee arthroplasty. Neuromuscul Disord 2017. [DOI: 10.1016/s0960-8966(17)30299-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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45
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Nguyen J, Su E, Lyman S, Manning E, Cummings K, Wu A, Sasaki M, Dalal A, Ching C, Shetty T. Incidence and risk factors for neuropathy following primary total hip arthroplasty. Neuromuscul Disord 2017. [DOI: 10.1016/s0960-8966(17)30298-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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46
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Maan S, Kumar A, Gupta AK, Dalal A, Chaudhary D, Gupta TK, Bansal N, Kumar V, Batra K, Sindhu N, Kumar A, Mahajan NK, Maan NS, Mertens PPC. Concurrent infection of Bluetongue and Peste-des-petits-ruminants virus in small ruminants in Haryana State of India. Transbound Emerg Dis 2017; 65:235-239. [PMID: 28116836 DOI: 10.1111/tbed.12610] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2016] [Indexed: 11/27/2022]
Abstract
Bluetongue (BT) and peste-des-petits-ruminants (PPR) are major transboundary diseases of small ruminant, which are endemic in India. Testing of bluetongue virus (BTV) and peste-des-petits-ruminants virus (PPRV) from recent outbreaks (2015-2016) in different regions of Haryana State of India revealed that 27.5% of the samples showed the presence of dual infection of BTV and PPRV. Analysis of Seg-2 of BTV (the serotype-determining protein) showed the presence of BTV-12w in several isolates. However, analysis of N gene fragment amplicons showed that viruses belong to lineage IV were most closely related to a pathogenic strain of PPRV from Delhi. This is the first report of co-circulation of PPRV lineage IV and bluetongue virus serotype 12 in the state.
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Affiliation(s)
- S Maan
- Department of Animal Biotechnology, College of Veterinary Sciences, Lala Lajpat Rai University of Veterinary and Animal Sciences, Hisar, Haryana, India
| | - Aman Kumar
- Department of Animal Biotechnology, College of Veterinary Sciences, Lala Lajpat Rai University of Veterinary and Animal Sciences, Hisar, Haryana, India
| | - A K Gupta
- Department of Veterinary Microbiology, College of Veterinary Sciences, Lala Lajpat Rai University of Veterinary and Animal Sciences, Hisar, Haryana, India
| | - A Dalal
- Department of Animal Biotechnology, College of Veterinary Sciences, Lala Lajpat Rai University of Veterinary and Animal Sciences, Hisar, Haryana, India.,Department of Veterinary Microbiology, College of Veterinary Sciences, Lala Lajpat Rai University of Veterinary and Animal Sciences, Hisar, Haryana, India
| | - D Chaudhary
- Department of Animal Biotechnology, College of Veterinary Sciences, Lala Lajpat Rai University of Veterinary and Animal Sciences, Hisar, Haryana, India
| | - T K Gupta
- Teaching Veterinary Clinical Complex, College of Veterinary Sciences, Lala Lajpat Rai University of Veterinary and Animal Sciences, Hisar, Haryana, India
| | - N Bansal
- Department of Animal Biotechnology, College of Veterinary Sciences, Lala Lajpat Rai University of Veterinary and Animal Sciences, Hisar, Haryana, India
| | - V Kumar
- Department of Animal Biotechnology, College of Veterinary Sciences, Lala Lajpat Rai University of Veterinary and Animal Sciences, Hisar, Haryana, India
| | - K Batra
- Department of Animal Biotechnology, College of Veterinary Sciences, Lala Lajpat Rai University of Veterinary and Animal Sciences, Hisar, Haryana, India
| | - N Sindhu
- Teaching Veterinary Clinical Complex, College of Veterinary Sciences, Lala Lajpat Rai University of Veterinary and Animal Sciences, Hisar, Haryana, India
| | - Ankit Kumar
- TVCC Regional Centre, Uchani (Karnal), College of Veterinary Sciences, Lala Lajpat Rai University of Veterinary and Animal Sciences, Hisar, Haryana, India
| | - N K Mahajan
- Veterinary Public Health & Epidemiology, College of Veterinary Sciences, Lala Lajpat Rai University of Veterinary and Animal Sciences, Hisar, Haryana, India
| | - N S Maan
- Department of Animal Nutrition and Resource faculty, Department of Animal Biotechnology, College of Veterinary Sciences, Lala Lajpat Rai University of Veterinary and Animal Sciences, Hisar, Haryana, India
| | - P P C Mertens
- The Pirbright Institute, Pirbright, Surrey, UK.,School of Veterinary Medicine and Science, University of Nottingham, Sutton Bonington Campus, Leicestershire, UK
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47
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Shirodkar S, Anande L, Dalal A, Desai C, Corrêa G, Das M, Laxmeshwar C, Mansoor H, Remartinez D, Trelles M, Isaakidis P. Surgical interventions for pulmonary tuberculosis in Mumbai, India: surgical outcomes and programmatic challenges. Public Health Action 2016; 6:193-198. [PMID: 27695683 DOI: 10.5588/pha.16.0043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2016] [Accepted: 08/03/2016] [Indexed: 11/10/2022] Open
Abstract
Setting: While surgery for pulmonary tuberculosis (PTB) is considered an important adjunct for specific cases, including drug-resistant tuberculosis, operational evidence on its feasibility and effectiveness is limited. Objective: To describe surgical outcomes and programmatic challenges of providing surgery for PTB in Mumbai, India. Design: A descriptive study of routinely collected data of surgical interventions for PTB from 2010 to 2014 in two Mumbai hospitals, one public, one private. Results: Of 85 patients, 5 (6%) died and 17 (20%) had complications, with wound infection being the most frequent. Repeat operation was required in 12 (14%) patients. Most procedures were performed on an emergency basis, and eligibility was established late in the course of treatment. Median time from admission to surgery was 51 days. Drug susceptibility test (DST) patterns and final treatment outcomes were not systematically collected. Conclusion: In a high-burden setting such as Mumbai, important data on surgery for PTB were surprisingly limited in both the private and public sectors. Eligibility for surgery was established late, culture and DST were not systematically offered, the interval between admission and surgery was long and TB outcomes were not known. Systematic data collection would allow for proper evaluation of surgery as adjunctive therapy for all forms of TB under programmatic conditions.
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Affiliation(s)
- S Shirodkar
- Chest Department, GTB Hospital, Sewri, Mumbai, India
| | - L Anande
- Chest Department, GTB Hospital, Sewri, Mumbai, India
| | - A Dalal
- Chest Department, Jupiter Hospital, Thane, India
| | - C Desai
- Chest Department, GTB Hospital, Sewri, Mumbai, India
| | - G Corrêa
- Médecins Sans Frontières (MSF), Operational Research, Mumbai, India
| | - M Das
- Médecins Sans Frontières (MSF), Operational Research, Mumbai, India
| | - C Laxmeshwar
- Médecins Sans Frontières (MSF), Operational Research, Mumbai, India
| | - H Mansoor
- Médecins Sans Frontières (MSF), Operational Research, Mumbai, India
| | - D Remartinez
- Médecins Sans Frontières (MSF), Operational Research, Mumbai, India
| | - M Trelles
- Medical Department, MSF, Brussels, Belgium
| | - P Isaakidis
- Médecins Sans Frontières (MSF), Operational Research, Mumbai, India
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48
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Uttarilli A, Ranganath P, Matta D, Md Nurul Jain J, Prasad K, Babu AS, Girisha KM, Verma IC, Phadke SR, Mandal K, Puri RD, Aggarwal S, Danda S, Sankar VH, Kapoor S, Bhat M, Gowrishankar K, Hasan AQ, Nair M, Nampoothiri S, Dalal A. Identification and characterization of 20 novel pathogenic variants in 60 unrelated Indian patients with mucopolysaccharidoses type I and type II. Clin Genet 2016; 90:496-508. [PMID: 27146977 DOI: 10.1111/cge.12795] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2016] [Revised: 04/23/2016] [Accepted: 05/01/2016] [Indexed: 11/30/2022]
Abstract
Mucopolysaccharidoses (MPS), a subgroup of lysosomal storage disorders, are caused due to deficiency of specific lysosomal enzyme involved in catabolism of glycosaminoglycans. To date more than 200 pathogenic variants in the alpha-l-iduronidase (IDUA) for MPS I and ∼500 pathogenic variants in the iduronate-2-sulphatase (IDS) for MPS II have been reported worldwide. The mutation spectrum of MPS type I and MPS type II disorders in Indian population is not characterized yet. In this study, we carried out clinical, biochemical, molecular and in silico analyses to establish the mutation spectrum of MPS I and MPS II in the Indian population. We conducted molecular analysis for 60 MPS-affected patients [MPS I (n = 30) (Hurler syndrome = 17, Hurler-Scheie syndrome = 13), and MPS II (n = 30) (severe = 18, attenuated = 12)] and identified a total of 44 [MPS I (n = 22) and MPS II (n = 22)] different pathogenic variants comprising missense, nonsense, frameshift, gross deletions and splice site variants. A total of 20 [MPS I (n = 14), and MPS II (n = 6)] novel pathogenic sequence variants were identified in our patient cohort. We found that 32% of pathogenic variants detected in IDUA were recurrent and 25% in MPS II. This is the first study revealing the mutation spectrum of MPS I and MPS II patients in the Indian population.
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Affiliation(s)
- A Uttarilli
- Diagnostics Division, Centre for DNA Fingerprinting and Diagnostics, Hyderabad, India.,Graduate Studies, Manipal University, Manipal, India
| | - P Ranganath
- Diagnostics Division, Centre for DNA Fingerprinting and Diagnostics, Hyderabad, India.,Department of Medical Genetics, Nizam's Institute of Medical Sciences, Hyderabad, India
| | - D Matta
- Diagnostics Division, Centre for DNA Fingerprinting and Diagnostics, Hyderabad, India
| | - J Md Nurul Jain
- Diagnostics Division, Centre for DNA Fingerprinting and Diagnostics, Hyderabad, India
| | - K Prasad
- Diagnostics Division, Centre for DNA Fingerprinting and Diagnostics, Hyderabad, India
| | - A S Babu
- Diagnostics Division, Centre for DNA Fingerprinting and Diagnostics, Hyderabad, India
| | - K M Girisha
- Department of Medical Genetics, Kasturba Medical College, Manipal, India
| | - I C Verma
- Center of Medical Genetics, Sir Ganga Ram Hospital, New Delhi, India
| | - S R Phadke
- Department of Medical Genetics, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - K Mandal
- Department of Medical Genetics, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - R D Puri
- Center of Medical Genetics, Sir Ganga Ram Hospital, New Delhi, India
| | - S Aggarwal
- Diagnostics Division, Centre for DNA Fingerprinting and Diagnostics, Hyderabad, India.,Department of Medical Genetics, Nizam's Institute of Medical Sciences, Hyderabad, India
| | - S Danda
- Department of Clinical Genetics, Christian Medical College and Hospital, Vellore, India
| | - V H Sankar
- Genetics Clinic, Department of Pediatrics, SAT Hospital, Government Medical College, Trivandrum, India
| | - S Kapoor
- Department of Pediatrics, Maulana Azad Medical College, New Delhi, India
| | - M Bhat
- Centre for Human Genetics, Bengaluru, India
| | | | - A Q Hasan
- Department of Genetics, Kamineni Hospital, Hyderabad, India
| | - M Nair
- Additional Professor in Pediatrics, Government Medical College, Manjeri, India
| | - S Nampoothiri
- Department of Pediatric Genetics, Amrita Institute of Medical Sciences, Kochi, India
| | - A Dalal
- Diagnostics Division, Centre for DNA Fingerprinting and Diagnostics, Hyderabad, India
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49
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Chaudhary AK, Mohapatra R, Nagarajaram HA, Ranganath P, Dalal A, Dutta A, Danda S, Girisha KM, Bashyam MD. The novel EDAR p.L397H missense mutation causes autosomal dominant hypohidrotic ectodermal dysplasia. J Eur Acad Dermatol Venereol 2016; 31:e17-e20. [PMID: 27168349 DOI: 10.1111/jdv.13587] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Affiliation(s)
| | - R Mohapatra
- Laboratory of Computational biology, Hyderabad, India
| | | | - P Ranganath
- Diagnostics Division, Centre for DNA Fingerprinting and Diagnostics, Hyderabad, India.,Nizam's Institute of Medical Sciences, Hyderabad, India
| | - A Dalal
- Diagnostics Division, Centre for DNA Fingerprinting and Diagnostics, Hyderabad, India
| | - A Dutta
- Christian Medical College, Vellore, India
| | - S Danda
- Christian Medical College, Vellore, India
| | - K M Girisha
- Department of Medical Genetics, Kasturba Medical College, Manipal University, Manipal, India
| | - M D Bashyam
- Laboratory of Molecular Oncology, Hyderabad, India
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50
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Bundy M, Rogerson N, Dalal A, Kerr R, Finch G, Read K, Kilvington C, McLennan A. Lingual frenectomy in infants and its effect on breastfeeding. Br J Oral Maxillofac Surg 2015. [DOI: 10.1016/j.bjoms.2015.08.114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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