1
|
Chavan R, Gandhi C, Rawal KK, Shah C, Patel N, Rajput S. Nasojejunal tube-related duodenal perforations: a multicenter experience. Clin Endosc 2023; 56:817-822. [PMID: 37536747 PMCID: PMC10665622 DOI: 10.5946/ce.2023.071] [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: 03/03/2023] [Accepted: 04/20/2023] [Indexed: 08/05/2023] Open
Affiliation(s)
- Radhika Chavan
- Department of Gastroenterology and Advanced Endoscopy, Ansh Clinic, Ahmedabad, Gujarat, India
| | - Chaiti Gandhi
- Department of Gastroenterology and Advanced Endoscopy, Ansh Clinic, Ahmedabad, Gujarat, India
| | - K K Rawal
- Department of Gastroenterology and Advanced Endoscopy, Prime Hospital, Rajkot, Gujarat, India
| | - Chirag Shah
- Department of Gastroenterology and Advanced Endoscopy, Mission Gastro Hospital, Ahmedabad, Gujarat, India
| | - Nisarg Patel
- Department of Gastroenterology and Endoscopy, Gujarat Gastro Hub, Mehsana, India
| | - Sanjay Rajput
- Department of Gastroenterology and Advanced Endoscopy, Ansh Clinic, Ahmedabad, Gujarat, India
| |
Collapse
|
2
|
Pawlak KM, Tehami N, Maher B, Asif S, Rawal KK, Balaban DV, Tag-Adeen M, Ghalim F, Abbas WA, Ghoneem E, Ragab K, El-Ansary M, Kadir S, Amin S, Siau K, Wiechowska-Kozlowska A, Mönkemüller K, Abdelfatah D, Abdellatef A, Lakhtakia S, Okasha HH. Role of endoscopic ultrasound in the characterization of solid pseudopapillary neoplasm of the pancreas. World J Gastrointest Endosc 2023; 15:273-284. [PMID: 37138939 PMCID: PMC10150282 DOI: 10.4253/wjge.v15.i4.273] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 02/17/2023] [Accepted: 03/29/2023] [Indexed: 04/14/2023] Open
Abstract
BACKGROUND Solid pseudopapillary neoplasm (SPN) is an uncommon pathology of the pancreas with unpredictable malignant potential. Endoscopic ultrasound (EUS) assessment plays a vital role in lesion characterization and confirmation of the tissue diagnosis. However, there is a paucity of data regarding the imaging assessment of these lesions.
AIM To determine the characteristic EUS features of SPN and define its role in preoperative assessment.
METHODS This was an international, multicenter, retrospective, observational study of prospective cohorts from 7 large hepatopancreaticobiliary centers. All cases with postoperative histology of SPN were included in the study. Data collected included clinical, biochemical, histological and EUS characteristics.
RESULTS One hundred and six patients with the diagnosis of SPN were included. The mean age was 26 years (range 9 to 70 years), with female predominance (89.6%). The most frequent clinical presentation was abdominal pain (80/106; 75.5%). The mean diameter of the lesion was 53.7 mm (range 15 to 130 mm), with the slight predominant location in the head of the pancreas (44/106; 41.5%). The majority of lesions presented with solid imaging features (59/106; 55.7%) although 33.0% (35/106) had mixed solid/cystic characteristics and 11.3% (12/106) had cystic morphology. Calcification was observed in only 4 (3.8%) cases. Main pancreatic duct dilation was uncommon, evident in only 2 cases (1.9%), whilst common bile duct dilation was observed in 5 (11.3%) cases. One patient demonstrated a double duct sign at presentation. Elastography and Doppler evaluation demonstrated inconsistent appearances with no emergence of a predictable pattern. EUS guided biopsy was performed using three different types of needles: Fine needle aspiration (67/106; 63.2%), fine needle biopsy (37/106; 34.9%), and Sonar Trucut (2/106; 1.9%). The diagnosis was conclusive in 103 (97.2%) cases. Ninety-seven patients were treated surgically (91.5%) and the post-surgical SPN diagnosis was confirmed in all cases. During the 2-year follow-up period, no recurrence was observed.
CONCLUSION SPN presented primarily as a solid lesion on endosonographic assessment. The lesion tended to be located in the head or body of the pancreas. There was no consistent characteristic pattern apparent on either elastography or Doppler assessment. Similarly SPN did not frequently cause stricture of the pancreatic duct or common bile duct. Importantly, we confirmed that EUS-guided biopsy was an efficient and safe diagnostic tool. The needle type used does not appear to have a significant impact on the diagnostic yield. Overall SPN remains a challenging diagnosis based on EUS imaging with no pathognomonic features. EUS guided biopsy remains the gold standard in establishing the diagnosis.
Collapse
Affiliation(s)
- Katarzyna M Pawlak
- Endoscopy Unit, Department of Gastroenterology, Hospital of The Ministry of Interior and Administration, Szczecin 01-218, Poland
| | - Nadeem Tehami
- Interventional Endoscopy Unit, University Hospital Southampton NHS Foundation Trust, 3AX PO, United Kingdom
| | - Ben Maher
- Interventional Endoscopy Unit, University Hospital Southampton NHS Foundation Trust, 3AX PO, United Kingdom
| | - Shujaath Asif
- Consultant Gastroenterologist, AIG Hospitals, Hyderabad 500032, India
| | - Krishn Kant Rawal
- Department of Gastroenterology, Prime Institute of Digestive Sciences, Rajkot 360001, India
| | - Daniel Vasile Balaban
- Department of Gastroenterology, Central Military Emergency University Hospital, Carol Davila University of Medicine and Pharmacy, Bucharest 010011, Romania
| | - Mohammed Tag-Adeen
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Qena Faculty of Medicine, South Valley University, Qena 83511, Egypt
- Department of Endoscopy, Shefa Al-Orman Hospital, Luxor 85951, Egypt
| | - Fahd Ghalim
- Interventional Endoscopy Unit, Sainte Marie Hospital, OSNY 95520, France
| | - Wael A Abbas
- Department of Internal Medicine, Gastroenterology Unit, Faculty of Medicine, Assuit University, Assuit 71511, Egypt
| | - Elsayed Ghoneem
- Department of Gastroenterology and Hepatology, Faculty of Medicine, Mansoura University, Mansoura 35511, Egypt
| | - Khaled Ragab
- Department of Hepatology and Gastroenterology, Theodor Bilharz Research Institute, Giza 12511, Egypt
| | - Mahmoud El-Ansary
- Department of Hepatology & Gastroenterology, Theodor Bilharz Research Institute, Giza 12511, Egypt
| | - Shanil Kadir
- Department of Gastroenterology, Liaquat National Hospital & Medical College, Karachi 75900, Pakistan
| | - Sunil Amin
- Division of Digestive and Liver Diseases, Department of Medicine, University of Miami Miller School of Medicine, Miami, FL 32118, United States
| | - Keith Siau
- Department of Gastroenterology, Royal Cornwall Hospitals NHS Trust, Truro, Cornwall, United Kingdom
| | | | - Klaus Mönkemüller
- Department of Gastroenterology, Virginia Tech Carilion School of Medicine, Roanoke, Virginia, AL 35294, United States
| | - Dalia Abdelfatah
- Department of Cancer Epidemiology and Biostatistics, National Cancer Institute, Cairo University, Cairo 11511, Egypt
| | - Abeer Abdellatef
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, Kasr Al-Aini School of Medicine, Faculty of Medicine, Cairo University, Cairo 11511, Egypt
| | - Sundeep Lakhtakia
- Consultant Gastroenterologist, AIG Hospitals, Hyderabad 500032, India
| | - Hussein Hassan Okasha
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, Kasr Al-Aini School of Medicine, Faculty of Medicine, Cairo University, Cairo 11451, Egypt
| |
Collapse
|
3
|
Rawal KK, Shukla VP, Chikani S, Thakkar M, Ruparelia M, Chudasama RK. Prevalence of extraintestinal manifestations in ulcerative colitis and associated risk factors. Indian J Gastroenterol 2021; 40:477-482. [PMID: 34569013 DOI: 10.1007/s12664-021-01181-9] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 04/15/2021] [Indexed: 02/04/2023]
Abstract
BACKGROUND The data on prevalence of extraintestinal manifestations (EIM) in ulcerative colitis (UC) are scanty and highly variable. METHODS Consecutive patients with UC were prospectively evaluated from November 2016 to August 2017. A detailed history was obtained and physical examination was done. Presence of EIM was confirmed by a consultant rheumatologist, ophthalmologist and dermatologist. Tests performed were hemogram, liver function test, abdominal ultrasound, slit lamp examination, X-ray and magnetic resonance imaging when deemed necessary. RESULTS A total of 227 patients with UC were enrolled in this study. The prevalence of EIM was 7.92%. Mucocutaneous (4.84%) manifestations were the commonest, followed by musculoskeletal (1.32%) and ocular (0.88%). Hepatobiliary (0.44%) and vascular (0.44) manifestations were present in equal frequency. History of appendicectomy was associated with EIM. CONCLUSION The prevalence of EIM in UC was low in our study. History of appendicectomy was a risk factor for EIM.
Collapse
Affiliation(s)
- Krishn Kant Rawal
- Prime Institute of Digestive Sciences, Panchvati Main Road, Rajkot, 360 004, India.
| | - Varun P Shukla
- Prime Institute of Digestive Sciences, Panchvati Main Road, Rajkot, 360 004, India
| | - Shabbir Chikani
- Milestone Hospital, Vidyanagar Main Road, Rajkot, 360 002, India
| | - Milan Thakkar
- Retina Care Centre, Virani Chowk, Vidyanagar Main Road, Rajkot, 360 002, India
| | - Mukesh Ruparelia
- Devarsh, 13-Manhar Plot, Mangala Main Road, Rajkot, 360 002, India
| | - Rajesh K Chudasama
- Department of Community Medicine, PDU Government Medical College, Rajkot, 360 001, India
| |
Collapse
|
4
|
Abstract
Laparoscopic cholecystectomy (LC) is currently the treatment of choice for symptomatic gallstones. Associated complications include bile duct injury, retained common bile duct (CBD) stones, and migration of surgical clips. Clip migration into the CBD can present with recurrent cholangitis over a period of time. Retained CBD stones can be another cause of recurrent cholangitis. A case of two surgical clips migrating into the common bile duct with few retained stones following LC is reported here. The patient had repeated episodes of fever, pain at epigastrium, jaundice, and pruritus 3 months after LC. Liver function tests revealed features of obstructive jaundice. Ultrasonography of the abdomen showed dilated CBD with few stones. In view of acute cholangitis, an urgent endoscopic retrograde cholangiopancreatography was done, which demonstrated few filling defects and 2 linear metallic densities in the CBD. A few retained stones along with 2 surgical clips were removed successfully from the CBD by endoscopic retrograde cholangiopancreatography after papillotomy using a Dormia basket. The patient improved dramatically following the procedure.
Collapse
Affiliation(s)
- Krishn Kant Rawal
- Department of Gastroenterology and Liver Disease, Milestone Hospital, Rajkot, India
| |
Collapse
|
5
|
Rawal KK. Colorectal Variceal Bleeding Managed by Endoscopic Therapy in Patients with Cirrhosis. J Assoc Physicians India 2016; 64:88-89. [PMID: 27739280] [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: 06/06/2023]
Abstract
Ectopic varices are an unusual cause of gastrointestinal bleeding accounting for upto 5% of all variceal bleeds. Colorectal variceal bleeding is even rare. As the bleed is massive and has a poor prognosis, one must be aware of this condition in a patient of portal hypertension with life-threatening lower gastrointestinal bleeding. Two cases of colorectal variceal bleeding in cirrhotic patients treated successfully by endoscopic therapy are reported here.
Collapse
Affiliation(s)
- K K Rawal
- Department of Gastroenterology and Liver Disease, Milestone Hospital, Rajkot, Gujarat
| |
Collapse
|
6
|
Affiliation(s)
- K K Rawal
- Department of Gastroenterology and Liver Disease, Milestone Hospital, Vidyanagar, Main Road, Rajkot, 360 002, India.
| |
Collapse
|
7
|
Puri AS, Rawal KK, Gupta R, Broor SL. Precipitation of acute intermittent porphyria by chloroquin. Indian Pediatr 1996; 33:241-3. [PMID: 8772850] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Affiliation(s)
- A S Puri
- Department of Gastroenterology, G.B. Pant Hospital, New Delhi
| | | | | | | |
Collapse
|
8
|
Rawal KK, Jain M, Sarin SK. Hepatorenal syndrome: current perspectives. J Assoc Physicians India 1996; 44:189-92, 197. [PMID: 9251317] [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] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
- K K Rawal
- Department of Gastroenterology, G.B.Pant Hospital, New Delhi
| | | | | |
Collapse
|
9
|
Puri AS, Kumar N, Mishra A, Gupta R, Lamba GS, Rawal KK, Broor SL. Clinical and endoscopic features of hereditary hemorrhagic telangiectasia (Osler-Weber-Rendu disease) in India. Trop Gastroenterol 1996; 17:35-40. [PMID: 8693584] [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: 02/01/2023]
Abstract
Hereditary hemorrhagic telangiectasis (HHT) is an autosomal dominant disease characterized by recurrent epistaxis and telangiectasia of the skin and mucous membranes. Most reports of HHT are from Europe and N. America. In this report of 7 patients from India we postulate that increased skin pigmentation in Asians and Negroids masks the cutaneous manifestations of the disease but without any discernible effect on mucosal lesions. The median hemoglobin value in these patients was 4 g/dl. Endoscopic lesions in the stomach or duodenum were detected in six patients. Most patients in our report (5/7) presented with a chronic iron deficiency anaemia. The treatment of HHT is mainly supportive although our preliminary data shows that low dose ethinyl estradiol therapy decreases transfusion requirement in these patients.
Collapse
Affiliation(s)
- A S Puri
- Department of Gastroenterology, G. B. Pant Hospital, New Delhi, India
| | | | | | | | | | | | | |
Collapse
|
10
|
Vij JC, Jain M, Rawal KK, Gulati RA, Govil A. Endoscopic management of large bile duct stones by mechanical lithotripsy. Indian J Gastroenterol 1995; 14:122-3. [PMID: 8868351] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Our experience in treating large common bile duct stones using Olympus basket mechanical lithotripter (BML 2Q) and Soehendra lithotripter is reported. METHODS Between July 1990 and December 1993, twenty two patients with common bile duct stones too large to be extracted by Dormia basket or balloon were treated with BML lithotripter or Soehendra lithotripter. RESULTS The stone diameters ranged from 1.5 to 2.8 cm. Fourteen patients required one session of lithotripsy, four patients two sessions each, and two patients three sessions each. BML lithotripter was used in 14 patients. In the remaining eight patients the stones were fragmented with Soehendra lithotripter when the basket got impacted while attempting extraction. Mechanical lithotripsy was successful in 20 patients (91%). Indwelling stent was used in one patient; one patient underwent surgery. CONCLUSION Mechanical lithotripsy is safe for the treatment of large common bile duct stones, with a success rate above ninety percent.
Collapse
Affiliation(s)
- J C Vij
- Department of Gastroenterology, G B Pant Hospital, New Delhi
| | | | | | | | | |
Collapse
|
11
|
Rawal KK, Jain M, Kumar N, Broor SL, Malhotra V. Spectrum of gastrointestinal malignancy over a period of 10 years at a tertiary referal center of India. Trop Gastroenterol 1995; 16:34-37. [PMID: 8838042] [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: 05/22/2023]
Abstract
We studied the frequency of different gastro intestinal malignancies (GIM) diagnosed in a given year, among patients attending gastroenterology department, and changing pattern of their occurrence over a period of 10 years (1984-1993). The records of all patients with histologically confirmed GIM were screened. Out of 83380 outdoor patients registered in the department over 10 years, there were a total of 1751 (2.1%) patients with GIM. The relative distribution of malignancy according to site was esophagus 36.0%, stomach 19.9%, liver secondaries 13.9%, colon 9.8%, periampullary 5.6%, gall pladder 4.5%, duodenum 3.0%, malignant ascites 2.6%, HCC 2.3% and pancreas 1.1%. Mean age for cancer of esophagus was 53.5 +/- 11.4 year, stomach 51.8 +/- 12.9, colon 49.1 +/- 16.7, duodenum 45.3 +/- 11.4, malignant ascites 51.8 +/- 13.1, pancreas 46.9 +/- 15.3 and HCC 52.5 +/- 12 years with an overall mean age of all GIM being 49.7 +/- 13.4 years. All malignancies were common in males except for cancer of gall bladder. The annual distribution of GIM did not confirm to a rising or declining trend with reference to the frequency of occurrence or age and sex distribution over the last decade.
Collapse
Affiliation(s)
- K K Rawal
- Deptt. of Gastroenterology, G.B. Pant Hospital New Delhi, India
| | | | | | | | | |
Collapse
|
12
|
Kumar N, Gupta R, Lamba GS, Mishra A, Jain M, Rawal KK, Jain AK, Puri SK. Endoscopic management of biliary pleural fistula. Trop Gastroenterol 1995; 16:40-2. [PMID: 8838044] [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] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Affiliation(s)
- N Kumar
- Dept. of Gastroenterology & Radiology, G.B. Pant Hospital, New Delhi
| | | | | | | | | | | | | | | |
Collapse
|
13
|
Gulati R, Rawal KK, Kumar N, Jain M, Puri AS, Govil A, Sachdeva AK, Chaudhary A. Course of severe ulcerative colitis in northern India. Trop Gastroenterol 1995; 16:19-23. [PMID: 8838038] [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: 02/02/2023]
Abstract
Thirty patients with severe ulcerative colitis were studied prospectively. Sixty percent (18/30) of severe ulcerative colitis were in remission after mean duration of 9.2 days (range 2-20 days) of intensive intravenous therapy without major side effects of steroids. Factors predicting poor response to medical therapy on admission are: stool frequency > or = 9 per day, pulse rate > or = 120/minute, temperature > or = 38 degrees C, Albumin < or = 2 gm, mucosal tags on plain x-ray abdomen and pancolitis.
Collapse
Affiliation(s)
- R Gulati
- Department of Gastroenterology, G.B. Pant Hospital, New Delhi
| | | | | | | | | | | | | | | |
Collapse
|
14
|
Kumar N, Govil A, Puri AS, Gulati R, Jain M, Rawal KK, Gupta R. Tuberculosis in ulcerative colitis: bird in the bush. Trop Gastroenterol 1994; 15:219-21. [PMID: 7618204] [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: 01/26/2023]
Abstract
Records of one hundred and two patients with idiopathic ulcerative colitis were retrospectively studied to estimate the prevalence of associated tuberculosis. There were 49 males and 53 females with a mean age of 33 +/- 13 years. Seven patients (3 pulmonary and 4 intestinal) had associated tuberculosis. All patients with intestinal tuberculosis were females and had small bowel involvement. Patients with co-existing tuberculosis were on steroids at the time of presentation and responded well to anti tubercular treatment with gradual weight gain and remission of diarrhoea and fever. We conclude that in India, the prevalence of tuberculosis is high in patients with idiopathic ulcerative colitis on steroids and a high degree of suspicion is required to detect these cases.
Collapse
Affiliation(s)
- N Kumar
- Department of Gastroenterology, G.B. Pant Hospital, Delhi
| | | | | | | | | | | | | |
Collapse
|