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Singh AK, Sachdeva S, Chittem R, Dalal A. Role of Biliary Stenting After Stone Clearance in Patients Awaiting Cholecystectomy: The Jury Is Still Out! Am J Gastroenterol 2024:00000434-990000000-01038. [PMID: 38372294 DOI: 10.14309/ajg.0000000000002587] [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: 02/20/2024]
Affiliation(s)
- Alok Kumar Singh
- Department of Gastroenterology, GB Pant Hospital, New Delhi, India
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Singh AK, Srivastava S, Sonika U, Sachdeva S, Aneesh P, Kumar A, Sharma BC, Dalal A. Motorized Power Spiral Enteroscopy (MSE): Is Routine Bougienage of the Upper Esophageal Sphincter (UES) Necessary? Cureus 2024; 16:e52342. [PMID: 38361713 PMCID: PMC10867537 DOI: 10.7759/cureus.52342] [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] [Accepted: 01/15/2024] [Indexed: 02/17/2024] Open
Abstract
Introduction Wire-guided bougienage of the upper esophageal sphincter (UES) was performed routinely before per-oral motorized power spiral enteroscopy (MSE). In the present study, we aimed to answer the clinical question of whether routine bougienage of UES is required. Methods This was a retrospective study that included 20 patients who underwent antegrade spiral enteroscopy for various indications. The feasibility and safety of anterograde MSE without prior bougie dilatation of the upper esophageal sphincter were assessed. The technical success rate (TSR), diagnostic yield, and adverse events (AEs) were also assessed. Results In 16 out of the 20 patients, a spiral enteroscope was taken directly across UES into the esophagus without a prior bougie dilatation. The spiral enteroscope could not be negotiated across UES only in one patient, and bougie dilatation was done. The technical success rate was 100%. The diagnostic yield was 80%. Four patients reported AEs. Conclusions MSE had a good technical success rate and diagnostic yield. Routine dilatation of the UES before the procedure may be unnecessary.
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Affiliation(s)
- Alok Kumar Singh
- Gastroenterology and Hepatology, G.B. Pant Hospital, New Delhi, IND
| | | | - Ujjwal Sonika
- Gastroenterology and Hepatology, G.B. Pant Hospital, New Delhi, IND
| | - Sanjeev Sachdeva
- Gastroenterology and Hepatology, G.B. Pant Hospital, New Delhi, IND
| | - Payila Aneesh
- Gastroenterology and Hepatology, G.B. Pant Hospital, New Delhi, IND
| | - Ajay Kumar
- Gastroenterology and Hepatology, G.B. Pant Hospital, New Delhi, IND
| | - Barjesh C Sharma
- Gastroenterology and Hepatology, G.B. Pant Hospital, New Delhi, IND
| | - Ashok Dalal
- Gastroenterology and Hepatology, G.B. Pant Hospital, New Delhi, IND
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Pandey T, Sonika U, Dalal A, Kumar A, Palle SH, Gera R, Choudhary H, Sachdeva S, Srivastava S, Sharma BC. Quality of life and nutritional status of patients with refractory or recurrent corrosive-induced esophageal strictures on long-term endoscopic dilation. Indian J Gastroenterol 2023:10.1007/s12664-023-01484-z. [PMID: 38044358 DOI: 10.1007/s12664-023-01484-z] [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: 12/05/2023]
Affiliation(s)
- Toshali Pandey
- Department of Gastroenterology, Maulana Azad Medical College, New Delhi, 110 002, India
| | - Ujjwal Sonika
- Department of Gastroenterology, G B Pant Institute of Postgraduate Medical Education and Research, Room No. 209 Academic Block, Jawahar Lal Nehru Marg, New Delhi, 110 002, India.
| | - Ashok Dalal
- Department of Gastroenterology, G B Pant Institute of Postgraduate Medical Education and Research, Room No. 209 Academic Block, Jawahar Lal Nehru Marg, New Delhi, 110 002, India
| | - Ajay Kumar
- Department of Gastroenterology, G B Pant Institute of Postgraduate Medical Education and Research, Room No. 209 Academic Block, Jawahar Lal Nehru Marg, New Delhi, 110 002, India
| | - Sri Harsha Palle
- Department of Gastroenterology, G B Pant Institute of Postgraduate Medical Education and Research, Room No. 209 Academic Block, Jawahar Lal Nehru Marg, New Delhi, 110 002, India
| | - Raghav Gera
- Department of Gastroenterology, Maulana Azad Medical College, New Delhi, 110 002, India
| | - Harshita Choudhary
- Department of Gastroenterology, Maulana Azad Medical College, New Delhi, 110 002, India
| | - Sanjeev Sachdeva
- Department of Gastroenterology, G B Pant Institute of Postgraduate Medical Education and Research, Room No. 209 Academic Block, Jawahar Lal Nehru Marg, New Delhi, 110 002, India
| | - Siddharth Srivastava
- Department of Gastroenterology, G B Pant Institute of Postgraduate Medical Education and Research, Room No. 209 Academic Block, Jawahar Lal Nehru Marg, New Delhi, 110 002, India
| | - Barjesh Chander Sharma
- Department of Gastroenterology, G B Pant Institute of Postgraduate Medical Education and Research, Room No. 209 Academic Block, Jawahar Lal Nehru Marg, New Delhi, 110 002, India
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Sachdeva S, George R, Dalal A, Kumar A. Paraneoplastic pseudoachalasia: A rare manifestation of Hodgkin's lymphoma. Indian J Gastroenterol 2023; 42:852-854. [PMID: 37067691 DOI: 10.1007/s12664-022-01302-y] [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: 04/18/2023]
Affiliation(s)
- Sanjeev Sachdeva
- Department of Gastroenterology, G B Pant Hospital, University of Delhi, New Delhi, 110 002, India.
| | - Roshan George
- Department of Gastroenterology, G B Pant Hospital, University of Delhi, New Delhi, 110 002, India
| | - Ashok Dalal
- Department of Gastroenterology, G B Pant Hospital, University of Delhi, New Delhi, 110 002, India
| | - Ajay Kumar
- Department of Gastroenterology, G B Pant Hospital, University of Delhi, New Delhi, 110 002, India
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Singh AK, Sachdeva S, Srivastava S, Sonika U, Kumar A, Sharma BC, Puri AS, Dalal A. Comparing Myelosuppression Frequency in Indian Inflammatory Bowel Disease Patients: A Randomized Trial of Full Dose Versus Gradual Escalation of Thiopurines. Cureus 2023; 15:e50969. [PMID: 38259414 PMCID: PMC10801346 DOI: 10.7759/cureus.50969] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/22/2023] [Indexed: 01/24/2024] Open
Abstract
INTRODUCTION We aimed to compare the frequency of myelosuppression in patients initiating azathioprine (AZA) at full dose versus those undergoing gradual dose escalation. METHODS Forty patients with inflammatory bowel disease were recruited over one year and randomized into two groups of 20. Group A initiated AZA at a full dose of 2 mg/kg, while group B started at 1 mg/kg with subsequent dose increases at regular intervals. RESULTS Seventeen patients from each group were included in the final analysis. During follow-up, two patients (11.8%) from group A and four patients (23.5%) from group B experienced relapses (p=0.65). Myelosuppression occurred in two patients (11.8%) from each group. Absolute neutrophil counts in group A tended to have lower median values than those in group B, particularly four weeks after AZA initiation. Univariate analysis identified serum proteins, albumin, and bilirubin as significantly associated with leukopenia, but these factors were not significant according to multivariate analysis. CONCLUSIONS The incidence of myelosuppression was similar between the groups. Patients with full-dose initiation of AZA had numerically fewer relapses during the follow-up period.
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Affiliation(s)
- Alok Kumar Singh
- Department of Gastroenterology, G.B. Pant Hospital, New Delhi, IND
| | - Sanjeev Sachdeva
- Department of Gastroenterology, G.B. Pant Hospital, New Delhi, IND
| | | | - Ujjwal Sonika
- Department of Gastroenterology, G.B. Pant Hospital, New Delhi, IND
| | - Ajay Kumar
- Department of Gastroenterology, G.B. Pant Hospital, New Delhi, IND
| | - Barjesh C Sharma
- Department of Gastroenterology, G.B. Pant Hospital, New Delhi, IND
| | - Amarender S Puri
- Department of Gastroenterology, Medanta - The Medicity Hospital, Gurugram, IND
| | - Ashok Dalal
- Department of Gastroenterology, G.B. Pant Hospital, New Delhi, IND
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Sharma BC, Maharshi S, Sachdeva S, Mahajan B, Sharma A, Bara S, Srivastava S, Kumar A, Dalal A, Sonika U. Nutritional therapy for persistent cognitive impairment after resolution of overt hepatic encephalopathy in patients with cirrhosis: A double-blind randomized controlled trial. J Gastroenterol Hepatol 2023; 38:1917-1925. [PMID: 37354045 DOI: 10.1111/jgh.16266] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Revised: 05/27/2023] [Accepted: 06/06/2023] [Indexed: 06/26/2023]
Abstract
BACKGROUND AND AIM Minimal hepatic encephalopathy (MHE) reflects cognitive impairment in patients with liver cirrhosis and is associated with poor prognosis. We assessed the effects of nutritional therapy on cognitive functions, health-related quality of life (HRQOL), anthropometry, endotoxins, and inflammatory markers in cirrhotic patients with MHE. METHODS In a double-blind randomized controlled trial, cirrhotic patients with MHE were randomized to nutritional therapy (group I: 30-35 kcal/kg/day and 1.0-1.5 g of protein/kg/day) and no nutritional therapy (group II: diet as patients were taking before) for 6 months. MHE was diagnosed based on psychometric hepatic encephalopathy score (PHES). Anthropometry, ammonia, endotoxins, inflammatory markers, myostatin, and HRQOL were assessed at baseline and after 6 months. Primary endpoints were improvement or worsening in MHE and HRQOL. RESULTS A total of 150 patients were randomized to group I (n = 75, age 46.3 ± 12.5 years, 58 men) and group II (n = 75, age 45.2 ± 9.3 years, 56 men). Baseline PHES (-8.16 ± 1.42 vs -8.24 ± 1.43; P = 0.54) was comparable in both groups. Reversal of MHE was higher in group I (73.2% vs 21.4%; P = 0.001) than group II. Improvement in PHES (Δ PHES 4.0 ± 0.60 vs -4.18 ± 0.40; P = 0.001), HRQOL (Δ Sickness Impact Profile 3.24 ± 3.63 vs 0.54 ± 3.58; P = 0.001), anthropometry, ammonia, endotoxins, cytokines, and myostatin levels was also significantly higher in group I than group II. Overt hepatic encephalopathy developed in 6 patients in group I and 13 in group II (P = 0.04). CONCLUSIONS Nutritional therapy is effective in treatment of MHE and associated with improvement in nutritional status, HRQOL, ammonia, endotoxins, inflammatory markers, and myostatin levels.
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Affiliation(s)
| | | | - Sanjeev Sachdeva
- Department of Gastroenterology, G.B. Pant Hospital, New Delhi, India
| | - Bhawna Mahajan
- Department of Biochemistry, G.B. Pant Hospital, New Delhi, India
| | - Ashok Sharma
- Department of Radiology, G.B. Pant Hospital, New Delhi, India
| | - Sushma Bara
- Department of Gastroenterology, G.B. Pant Hospital, New Delhi, India
| | | | - Ajay Kumar
- Department of Gastroenterology, G.B. Pant Hospital, New Delhi, India
| | - Ashok Dalal
- Department of Gastroenterology, G.B. Pant Hospital, New Delhi, India
| | - Ujjwal Sonika
- Department of Gastroenterology, G.B. Pant Hospital, New Delhi, India
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Sachdeva S, Vaithiyam VS, Srivastava S, Dalal A. Endoscopic ultrasound related partial splenic artery embolization: A gifted outcome. Indian J Gastroenterol 2023; 42:734-735. [PMID: 36719542 DOI: 10.1007/s12664-022-01301-z] [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: 02/01/2023]
Affiliation(s)
- Sanjeev Sachdeva
- Department of Gastroenterology, G B Pant Hospital, New Delhi, 110 002, India.
| | | | | | - Ashok Dalal
- Department of Gastroenterology, G B Pant Hospital, New Delhi, 110 002, India
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George R, Sonika U, Mahajan B, Sharma A, Dalal A, Sachdeva S, Kumar A. Diagnostic utility of urine neutrophil gelatinase-associated lipocalin and renal resistive index in patients of decompensated cirrhosis with acute kidney injury. Dig Liver Dis 2023; 55:1230-1235. [PMID: 37244788 DOI: 10.1016/j.dld.2023.03.002] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 02/18/2023] [Accepted: 03/10/2023] [Indexed: 05/29/2023]
Abstract
BACKGROUND The differentiation between types of acute kidney injury(AKI) in decompensated cirrhosis(DC) patients in clinical practice is done by clinical adjudication. Biomarkers have good diagnostic accuracy for predicting acute tubular necrosis(ATN), however they are not available routinely. AIMS We compared the diagnostic accuracy of urine neutrophil gelatinase-associated lipocalin(UNGAL) and renal resistive index(RRI) in predicting type of AKI among DC patients. METHODS Consecutive DC patients with AKI stage≥1B seen between June/2020 to May/2021 were evaluated. UNGAL levels and RRI were measured at diagnosis of AKI(Day 0) and 48hrs(Day 3) after volume expansion. Diagnostic accuracy of UGNAL and RRI was compared for differentiating ATN and non-ATN AKI by area under receiver operating characteristic curve(AUROC), using clinical adjudication as gold standard. RESULTS 388 DC patients were screened, 86 patients(Pre-renal AKI[PRA] n=47,55%; Hepatorenal syndrome[HRS] n=25,29%;ATN n= 14,16%) were included. The AUROC of UNGAL for differentiating ATN-AKI and non-ATN AKI at day 0 was 0.97(95%CI, 0.95-1.0) and on day 3 was 0.97(95%CI, 0.94-1.0). The AUROC of RRI for differentiating ATN and non-ATN AKI at day 0 was 0.68(95%CI, 0.55-0.80) and on day 3 was 0.74(95%CI, 0.63-0.84). CONCLUSION UNGAL has an excellent diagnostic accuracy in predicting ATN-AKI in DC patients both at day 0 and 3.
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Affiliation(s)
- Roshan George
- Department of Gastroenterology, Govind Ballabh Pant Institute of Post Graduate Medical Education and Research, 110002 New Delhi, India
| | - Ujjwal Sonika
- Department of Gastroenterology, Govind Ballabh Pant Institute of Post Graduate Medical Education and Research, 110002 New Delhi, India
| | - Bhawna Mahajan
- Department of Biochemistry, Govind Ballabh Pant Institute of Post Graduate Medical Education and Research, 110002 New Delhi, India
| | - Ashok Sharma
- Department of Radiology, Govind Ballabh Pant Institute of Post Graduate Medical Education and Research, 110002 New Delhi, India
| | - Ashok Dalal
- Department of Gastroenterology, Govind Ballabh Pant Institute of Post Graduate Medical Education and Research, 110002 New Delhi, India
| | - Sanjeev Sachdeva
- Department of Gastroenterology, Govind Ballabh Pant Institute of Post Graduate Medical Education and Research, 110002 New Delhi, India
| | - Ajay Kumar
- Department of Gastroenterology, Govind Ballabh Pant Institute of Post Graduate Medical Education and Research, 110002 New Delhi, India.
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Chauhan V, Nekarakanti PK, Balachandra D, Choudhary D, Sachdeva S, Nag HH. The outcome of 100 patients with achalasia cardia following laparoscopic Heller myotomy with blunt dissection technique. J Minim Access Surg 2023; 19:408-413. [PMID: 37282436 PMCID: PMC10449042 DOI: 10.4103/jmas.jmas_273_22] [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: 10/07/2022] [Accepted: 12/08/2022] [Indexed: 06/08/2023] Open
Abstract
Background Laparoscopic Heller myotomy (LHM) can be performed by blunt dissection technique (BDT). Only a few studies have assessed long-term outcomes and relief of dysphagia following LHM. The study reviews our long-term experience following LHM by BDT. Methods This retrospective study was analysed from a prospectively maintained database (from 2013 to 2021) of a single unit of the Department of Gastrointestinal Surgery at G. B. Pant Institute of Postgraduate Medical Education and Research, New Delhi. The myotomy was performed by BDT in all patients. A fundoplication was added in selected patients. Post-operative Eckardt score >3 was considered treatment failure. Results A total of 100 patients underwent surgery during the study period. Of them, 66 patients underwent LHM, 27 underwent LHM with Dor fundoplication and 7 underwent LHM with Toupet fundoplication. The median length of myotomy was 7 cm. The mean operative time was 77 ± 29.27 min and the mean blood loss of 28.05 ± 16.06 ml. Five patients had intraoperative oesophageal perforation. The median length of hospital stay was 2 days. There was no hospital mortality. The post-operative integrated relaxation pressure (IRP) was significantly lower than the mean pre-operative IRP (9.78 vs. 24.77). Eleven patients developed treatment failure, of which ten patients presented with recurrence of dysphagia. There was no difference in symptom-free survival amongst various types of achalasia cardia (P = 0.816). Conclusion LHM performed by BDT has a 90% success rate. Complication using this technique is rare, and recurrence post-surgery can be managed with endoscopic dilatation.
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Affiliation(s)
- Vivek Chauhan
- Department of Gastrointestinal Surgery, Govind Ballabh Pant Institute of Postgraduate Medical Education and Research, New Delhi, India
| | - Phani Kumar Nekarakanti
- Department of Gastrointestinal Surgery, Govind Ballabh Pant Institute of Postgraduate Medical Education and Research, New Delhi, India
| | - Deepak Balachandra
- Department of Gastrointestinal Surgery, Govind Ballabh Pant Institute of Postgraduate Medical Education and Research, New Delhi, India
| | - Devendra Choudhary
- Department of Gastrointestinal Surgery, Govind Ballabh Pant Institute of Postgraduate Medical Education and Research, New Delhi, India
| | - Sanjeev Sachdeva
- Department of Gastroenterology, Govind Ballabh Pant Institute of Postgraduate Medical Education and Research, New Delhi, India
| | - Hirdaya Hulas Nag
- Department of Gastrointestinal Surgery, Govind Ballabh Pant Institute of Postgraduate Medical Education and Research, New Delhi, India
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Sachdeva S, Kumbar C, Lone S, Dalal A, Goyal S. Fungating umbilical nodule in gastric carcinoma. Indian J Gastroenterol 2023:10.1007/s12664-023-01392-2. [PMID: 37378807 DOI: 10.1007/s12664-023-01392-2] [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: 06/29/2023]
Affiliation(s)
- Sanjeev Sachdeva
- Department of Gastroenterology, G B Pant Hospital, University of Delhi, New Delhi, 110 002, India.
| | - Chidanand Kumbar
- Department of Gastroenterology, G B Pant Hospital, University of Delhi, New Delhi, 110 002, India
| | - Shabir Lone
- Department of Gastroenterology, G B Pant Hospital, University of Delhi, New Delhi, 110 002, India
| | - Ashok Dalal
- Department of Gastroenterology, G B Pant Hospital, University of Delhi, New Delhi, 110 002, India
| | - Surbhi Goyal
- Department of Pathology, G B Pant Hospital, University of Delhi, New Delhi, 110 002, India
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Pandey T, Sonika U, Dalal A, Kumar A, Gera R, Choudhary H, Sachdeva S, Srivastava S, Sharma BC. Validity and Reliability of the European Organization Research and Treatment of Cancer Quality of Life Questionnaire-Oesophagogastric 25 in Indian Patients With Corrosive-Induced Benign Refractory Esophageal Strictures. Cureus 2023; 15:e37190. [PMID: 37159769 PMCID: PMC10163362 DOI: 10.7759/cureus.37190] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/05/2023] [Indexed: 04/09/2023] Open
Abstract
Background The European organization Research and Treatment of Cancer Quality of Life Questionnaire-Oesophagogastric 25 (EORTC QLQ-OG 25) is designed for patients with esophagogastric cancer. Its performance has never been tested with benign disorders. A health-related quality-of-life questionnaire does not exist for patients with benign corrosive-induced esophageal strictures. Hence, we evaluated the EORTC QLQ-OG 25 in Indian patients with corrosive strictures. Methods The English or Hindi version of QLQ-OG 25 was administered to 31 adult patients undergoing outpatient esophageal dilation at GB Pant hospital, New Delhi. These patients had refractory or recurrent esophageal strictures due to corrosive ingestion and had not undergone reconstructive surgery. Score distribution was analyzed, and item performance was determined based on floor and ceiling effects. Convergent validity, discriminant validity, and internal consistency were checked. Results The average time to finish the questionnaire was 6.70 minutes. Most scales fulfilled convergent validity (corrected item-total correlation >0.4), barring the Odynophagia scale and one item of the Dysphagia scale. Most scales exhibited divergent validity except for odynophagia and one item of dysphagia. Cronbach's alpha was >0.70 for all scales except odynophagia. Responses to questions evaluating taste, cough, swallowing saliva, and talking were highly skewed and had prominent floor effects. Overall, the questionnaire demonstrated good internal consistency, convergent validity, and divergent validity in benign corrosive-induced refractory esophageal strictures patients. Conclusion The EORTC QLQ-OG 25 can be satisfactorily used in patients with benign esophageal strictures to assess health-related quality of life.
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Ghoshal UC, Sachdeva S, Pratap N, Karyampudi A, Mustafa U, Abraham P, Bhatt CB, Chakravartty K, Chaudhuri S, Goyal O, Makharia GK, Panigrahi MK, Parida PK, Patwari S, Sainani R, Sadasivan S, Srinivas M, Upadhyay R, Venkataraman J. Indian consensus statements on irritable bowel syndrome in adults: A guideline by the Indian Neurogastroenterology and Motility Association and jointly supported by the Indian Society of Gastroenterology. Indian J Gastroenterol 2023; 42:249-273. [PMID: 36961659 PMCID: PMC10036984 DOI: 10.1007/s12664-022-01333-5] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Accepted: 12/20/2022] [Indexed: 03/25/2023]
Abstract
The Indian Neurogastroenterology and Motility Association (INMA), earlier named the Indian Motility and Functional Diseases Association developed this evidence-based practice guidelines for the management of irritable bowel syndrome (IBS). A modified Delphi process was used to develop this consensus containing 28 statements, which were concerning diagnostic criteria, epidemiology, etiopathogenesis and comorbidities, investigations, lifestyle modifications and treatments. Owing to the Coronavirus disease-19 (COVID-19) pandemic, lockdowns and mobility restrictions, web-based meetings and electronic voting were the major tools used to develop this consensus. A statement was regarded as accepted when the sum of "completely accepted" and "accepted with minor reservation" voted responses were 80% or higher. Finally, the consensus was achieved on all 28 statements. The consensus team members are of the view that this work may find use in teaching, patient care, and research on IBS in India and other nations.
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Affiliation(s)
- Uday C Ghoshal
- Department of Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, 226 014, India.
| | - Sanjeev Sachdeva
- Department of Gastroenterology, GB Pant Hospital, New Delhi, 110 002, India
| | - Nitesh Pratap
- Department of Gastroenterology, KIMS Hospital, Secunderabad, 500 003, India
| | - Arun Karyampudi
- Department of Gastroenterology, GSL Medical College and General Hospital, Rajahmundry , 533 296, India
| | - Uzma Mustafa
- Department of Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, 226 014, India
| | - Philip Abraham
- Department of Gastroenterology, P. D. Hinduja Hospital, Mumbai, 400 016, India
| | - Chetan B Bhatt
- Sir HN Reliance Foundation Hospital, Mumbai, 400 004, India
| | - Karmabir Chakravartty
- Department of Gastroenterology, Woodland Multispeciality Hospital, Kolkata, 700 027, India
| | - Sujit Chaudhuri
- Department of Gastroenterology, AMRI Hospitals, Salt Lake, Kolkata, 700 098, India
| | - Omesh Goyal
- Department of Gastroenterology, Dayanand Medical College and Hospital, Ludhiana, 141 001, India
| | - Govind K Makharia
- Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, 110 029, India
| | - Manas Kumar Panigrahi
- Department of Gastroenterology, All India Institute of Medical Sciences, Bhubaneswar, 751 019, India
| | - Prasanta Kumar Parida
- Department of Gastroenterology, SCB Medical College and Hospital, Cuttack, 753 001, India
| | | | - Rajesh Sainani
- Department of Gastroenterology, Jaslok Hospital, Mumbai, 400 026, India
| | - Shine Sadasivan
- Department of Gastroenterology, Amrita Institute of Medical Sciences, Kochi, 682 041, India
| | - M Srinivas
- Department of Gastroenterology, Gleneagles Global Health City, Chennai, 600 100, India
| | - Rajesh Upadhyay
- Department of Gastroenterology, Max Superspeciality Hospital, New Delhi, 110 017, India
| | - Jayanthi Venkataraman
- Department of Gastroenterology, Sri Ramachandra Institute of Higher Education and Research, Chennai, 600 116, India
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Ahuja H, Sharma BC, Sachdeva S, Mahajan B, Sharma A, Bara S, Srivastava S, Kumar A, Dalal A, Sonika U. A double blind randomized controlled trial to assess efficacy of nutritional therapy for prevention of recurrence of hepatic encephalopathy in patients with cirrhosis. J Gastroenterol Hepatol 2023; 38:433-440. [PMID: 36574769 DOI: 10.1111/jgh.16096] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 12/05/2022] [Accepted: 12/23/2022] [Indexed: 12/29/2022]
Abstract
BACKGROUND AND AIM Overt hepatic encephalopathy (OHE) has high risk of recurrence and is associated with poor survival. The role of nutrition therapy is well documented in cirrhosis, but its efficacy in preventing the recurrence of OHE has not been studied. METHODS In double blind RCT, we randomly assigned 150 patients with liver cirrhosis, with history of OHE in recent past to receive nutrition therapy (group I) or no nutrition therapy (group II) and followed up for 6 months. The primary efficacy end points were occurrence of breakthrough episodes and time to breakthrough episode of OHE. Secondary end points were OHE related hospitalizations and time to hospitalization involving OHE. Other parameters included anthropometry, changes in serum cytokines (IL-1, IL-6, IL-10, and TNF-α), endotoxin and myostatin. RESULTS There was significant reduction in occurrence of breakthrough episodes of OHE in group I [10 vs 36, hazard ratio 0.20; P < 0.001], OHE-related hospitalization [8 vs 24, hazard ratio 0.27; P < 0.001)]. Times to breakthrough episode of OHE and OHE-related hospitalization were longer in group I. At the end of 6 months, inflammatory and anthropometry parameters showed significant improvement in group I compared with worsening of serum albumin, anthropometric parameters, IL-6, IL-10 and TNF-α in group II. At the end of 6 months, ascites (50 vs 66, P = 0.01), gastrointestinal bleed (2 vs 11, P = 0.007), and jaundice (16 vs 41, P < 0.001) were lower in group I. CONCLUSIONS Treatment with nutrition therapy prevented recurrence of OHE and decreased OHE-related hospitalizations as compared with no nutrition therapy.
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Affiliation(s)
- Hardik Ahuja
- Department of Gastroenterology, GB Pant Hospital, New Delhi, India
| | | | - Sanjeev Sachdeva
- Department of Gastroenterology, GB Pant Hospital, New Delhi, India
| | - Bhawna Mahajan
- Department of Biochemistry, GB Pant Hospital, New Delhi, India
| | - Ashok Sharma
- Department of Radiology, GB Pant Hospital, New Delhi, India
| | - Sushma Bara
- Department of Gastroenterology, GB Pant Hospital, New Delhi, India
| | | | - Ajay Kumar
- Department of Gastroenterology, GB Pant Hospital, New Delhi, India
| | - Ashok Dalal
- Department of Gastroenterology, GB Pant Hospital, New Delhi, India
| | - Ujjwal Sonika
- Department of Gastroenterology, GB Pant Hospital, New Delhi, India
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14
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Gwee KA, Lee YY, Suzuki H, Ghoshal UC, Holtmann G, Bai T, Barbara G, Chen MH, Chua ASB, Gibson PR, Hou X, Liu J, Nakajima A, Pratap N, Sachdeva S, Siah KTH, Soh AYS, Sugano K, Tack J, Tan VPY, Tang X, Walker M, Wu DC, Xiao YL, Zulkifli KK, Toh C. Asia-Pacific guidelines for managing functional dyspepsia overlapping with other gastrointestinal symptoms. J Gastroenterol Hepatol 2023; 38:197-209. [PMID: 36321167 DOI: 10.1111/jgh.16046] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 06/17/2022] [Revised: 09/06/2022] [Accepted: 10/13/2022] [Indexed: 11/30/2022]
Abstract
Contemporary systems for the diagnosis and management gastrointestinal symptoms not attributable to organic diseases (Functional GI Disorders, FGID, now renamed Disorders of Gut-Brain Interaction, DGBI) seek to categorize patients into narrowly defined symptom-based sub-classes to enable targeted treatment of patient cohorts with similar underlying putative pathophysiology. However, an overlap of symptom categories frequently occurs and has a negative impact on treatment outcomes. There is a lack of guidance on their management. An Asian Pacific Association of Gastroenterology (APAGE) working group was set up to develop clinical practice guidelines for management of patients with functional dyspepsia (FD) who have an overlap with another functional gastrointestinal disorder: FD with gastroesophageal reflux (FD-GERD), epigastric pain syndrome with irritable bowel syndrome (EPS-IBS), postprandial distress syndrome with IBS (PDS-IBS), and FD-Constipation. We identified putative pathophysiology to provide a basis for treatment recommendations. A management algorithm is presented to guide primary and secondary care clinicians.
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Affiliation(s)
- Kok-Ann Gwee
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, and The Gastroenterology Group, Gleneagles Hospital, Singapore City, Singapore
| | - Yeong Yeh Lee
- School of Medical Sciences, Universiti Sains Malaysia, Kota Bharu, Malaysia.,GI Function and Motility Unit, Hospital Universiti Sains Malaysia, Kota Bharu, Malaysia
| | - Hidekazu Suzuki
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Tokai University School of Medicine, Isehara, Japan
| | - Uday Chand Ghoshal
- Department of Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Gerald Holtmann
- Faculty of Medicine and Faculty of Health and Behavioural Sciences, Department of Gastroenterology and Hepatology, University of Queensland, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia
| | - Tao Bai
- Division of Gastroenterology, Union Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Giovanni Barbara
- Department of Internal Medicine and Gastroenterology, and CRBA, University of Bologna, Bologna, Italy
| | - Min-Hu Chen
- Division of Gastroenterology and Hepatology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | | | - Peter R Gibson
- Department of Gastroenterology, Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Xiaohua Hou
- Division of Gastroenterology, Union Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jinsong Liu
- Division of Gastroenterology, Union Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Atsushi Nakajima
- Department of Gastroenterology and Hepatology, Yokohama City University School of Medicine, Yokohama, Japan
| | - Nitesh Pratap
- Krishna Institute of Medical Sciences, Secunderabad, India
| | - Sanjeev Sachdeva
- Department of Gastroenterology, GB Pant Hospital, New Delhi, India
| | - Kewin Tien Ho Siah
- Division of Gastroenterology and Hepatology, University Medicine Cluster, National University Health System; Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore City, Singapore
| | - Alex Yu Sen Soh
- Division of Gastroenterology and Hepatology, University Medicine Cluster, National University Health System; Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore City, Singapore
| | | | - Jan Tack
- Department of Gastroenterology, University Hospitals Leuven, Leuven, Belgium
| | - Victoria Ping Yi Tan
- Department of Medicine, University of Hong Kong, Queen Mary Hospital, Hong Kong SAR, China
| | - Xudong Tang
- Institute of Gastroenterology, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Marjorie Walker
- Anatomical Pathology College of Health, Medicine and Wellbeing, University of Newcastle, New South Wales, Australia
| | - Deng-Chyang Wu
- Division of Gastroenterology, Department of Internal Medicine, and Department of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Ying-Lian Xiao
- Division of Gastroenterology and Hepatology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Khairil Khuzaini Zulkifli
- GI Function and Motility Unit, Hospital Universiti Sains Malaysia, Kota Bharu, Malaysia.,Faculty of Medicine, Universiti Teknologi MARA, Sungai Buloh, Malaysia
| | - Clarissa Toh
- Stomach, Liver and Bowel Centre, Gleneagles Hospital, Singapore City, Singapore
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15
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Kumar M, Sonika U, Sachdeva S, Dalal A, Narang P, Mahajan B, Singhal A, Srivastava S. Natural History of Asymptomatic Walled-off Necrosis in Patients With Acute Pancreatitis. Cureus 2023; 15:e34646. [PMID: 36895535 PMCID: PMC9990741 DOI: 10.7759/cureus.34646] [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] [Accepted: 01/30/2023] [Indexed: 02/07/2023] Open
Abstract
Background and objectives Studies on the natural history of asymptomatic walled-off necrosis (WON) in acute pancreatitis (AP) are scarce. We conducted a prospective observational study to look for the incidence of infection in WON. Material and methods In this study, we included 30 consecutive AP patients with asymptomatic WON. Their baseline clinical, laboratory, and radiological parameters were recorded and followed up for three months. Mann Whitney U test and unpaired t-tests were used for quantitative data and chi-square and Fisher's exact tests were used for qualitative data analysis. A p-value <0.05 was considered significant. Receiver operating characteristic curve (ROC) analysis was done to identify the appropriate cutoffs for the significant variables. Results Of the 30 patients enrolled, 25 (83.3%) were males. Alcohol was the most common etiology. Eight patients (26.6%) developed an infection on follow-up. All were managed by drainage either percutaneously (n=4, 50%) or endoscopically (n=3, 37.5%). One patient required both. No patient required surgery and there was no mortality. Median baseline C-reactive protein (CRP) was higher in infection group 76 (IQR=34.8) mg/L vs asymptomatic group, 9.5 mg/dl (IQR=13.6), p<0.001. IL-6 and tumor necrosis factor (TNF)-alpha was also higher in the infection group. The size of the largest collection (157.50±33.59 mm vs 81.95±26.22 mm, P<0.001) and CT severity index (CTSI) (9.50±0.93 vs 7.82±1.37, p<0.01) were also higher in infection group as compared to the asymptomatic group. ROC curve analysis of baseline CRP (cutoff 49.5mg/dl), size of WON (cutoff 127mm) and CTSI (cutoff of 9) showed AUROC (area under ROC) of 1, 0.97, and 0.81 respectively for the future development of infection in WON. Conclusion Around one-fourth of asymptomatic WON patients developed an infection during three-months follow-up. Most patients with infected WON can be managed conservatively.
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Affiliation(s)
- Manish Kumar
- Gastroenterology, Govind Ballabh Pant Hospital, New Delhi, IND
| | - Ujjwal Sonika
- Gastroenterology, Govind Ballabh Pant Hospital, New Delhi, IND
| | | | - Ashok Dalal
- Gastroenterology, Govind Ballabh Pant Hospital, New Delhi, IND
| | - Poonam Narang
- Radiology, Govind Ballabh Pant Hospital, New Delhi, IND
| | - Bhawna Mahajan
- Biochemistry, Govind Ballabh Pant Hospital, New Delhi, IND
| | - Ankush Singhal
- Biochemistry, Govind Ballabh Pant Hospital, New Delhi, IND
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16
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Sachdeva S, George R, Dalal A, Goyal S. Primary pancreatic echinococcosis: A rare mimicking of choledochal cyst. Dig Liver Dis 2022; 54:1727-1728. [PMID: 35792036 DOI: 10.1016/j.dld.2022.06.011] [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: 05/24/2022] [Revised: 06/10/2022] [Accepted: 06/13/2022] [Indexed: 12/30/2022]
Affiliation(s)
- Sanjeev Sachdeva
- Departments of Gastroenterology, GB Pant Hospital, New Delhi 110002, India.
| | - Roshan George
- Departments of Gastroenterology, GB Pant Hospital, New Delhi 110002, India
| | - Ashok Dalal
- Departments of Gastroenterology, GB Pant Hospital, New Delhi 110002, India
| | - Surbhi Goyal
- Departments of Pathology, GB Pant Hospital, New Delhi 110002, India
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17
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Dahale AS, Srivastava S, Saluja SS, Sachdeva S, Dalal A, Varakanahalli S. Correction to: Management of scope-induced type I duodenal perforations: Over-the-scope clip versus surgery. Indian J Gastroenterol 2022:10.1007/s12664-022-01309-5. [PMID: 36385354 DOI: 10.1007/s12664-022-01309-5] [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: 11/18/2022]
Affiliation(s)
- Amol S Dahale
- Department of Gastroenterology, Dr. D Y Patil Medical College and Hospital, Pimpri, Pune, 411 018, India
| | - Siddharth Srivastava
- Department of Gastroenterology, G B Pant Institute of Postgraduate Medical Education and Research, 1, J L N Marg, New Delhi, 110 002, India.
| | - Sundeep Singh Saluja
- Department of Gastrointestinal Surgery, G B Pant Institute of Postgraduate Medical Education and Research, New Delhi, 110 002, India
| | - Sanjeev Sachdeva
- Department of Gastroenterology, G B Pant Institute of Postgraduate Medical Education and Research, 1, J L N Marg, New Delhi, 110 002, India
| | - Ashok Dalal
- Department of Gastroenterology, G B Pant Institute of Postgraduate Medical Education and Research, 1, J L N Marg, New Delhi, 110 002, India
| | - Shivakumar Varakanahalli
- Department of Gastroenterology, G B Pant Institute of Postgraduate Medical Education and Research, 1, J L N Marg, New Delhi, 110 002, India
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18
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Affiliation(s)
- Sanjeev Sachdeva
- Department of Gastroenterology, G B Pant Hospital, New Delhi, 110 002, India
| | - Ujjwal Sonika
- Department of Gastroenterology, G B Pant Hospital, New Delhi, 110 002, India.
| | - Ashok Dalal
- Department of Gastroenterology, G B Pant Hospital, New Delhi, 110 002, India
| | - Sukrit Singh Sethi
- Department of Gastroenterology, G B Pant Hospital, New Delhi, 110 002, India
| | - Manish Kumar
- Department of Gastroenterology, G B Pant Hospital, New Delhi, 110 002, India
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19
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Sonika U, Sachdeva S, Kumar A, Srivastava S, Dahale A, Sharma BC, Kumar M, Pandey T, Yadav DP, Maharshi S, Nair SV, Dalal A. Impact of the COVID-19 Pandemic on Gastroenterology Training in India. Journal of Digestive Endoscopy 2022. [DOI: 10.1055/s-0042-1748636] [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: 10/17/2022] Open
Abstract
Abstract
Introduction The coronavirus disease 2019 (COVID-19) pandemic has affected the healthcare system. The residents who are at the frontline of this pandemic have suffered the most. The extent of the training loss due to the COVID-19 pandemic on gastroenterology (GE) training is not studied in India.
Methods We designed a 36-question based google survey and distributed it to the GE residents all across India, via email. All the responses collected were analyzed using appropriate statistical methods.
Results A total of 140 responses were received. No significant decrease in teaching sessions/ classes was reported. Most of the residents (83.5%) reported inability to complete the target thesis enrolment. The number of patients seen by the residents in outpatient department, patients managed in wards and endoscopic procedures done by residents have decreased significantly (p-valve <0.001 for all). An overwhelming 89.9% (n = 125) of the GE residents were posted for COVID-19 duties. Almost half (50.4%) of them were COVID-19 positive.
Conclusion The COVID-19 pandemic has affected the training of GE residents in India immensely and an extension period of 3 months may be offered to them.
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Affiliation(s)
- Ujjwal Sonika
- Department of Gastroenterology, GB Pant Hospital, New Delhi, India
| | - Sanjeev Sachdeva
- Department of Gastroenterology, GB Pant Hospital, New Delhi, India
| | - Ajay Kumar
- Department of Gastroenterology, GB Pant Hospital, New Delhi, India
| | | | - Amol Dahale
- Department of Gastroenterology, DY Patil Medical College, Pune, Maharashtra, India
| | | | - Manish Kumar
- Department of Gastroenterology, GB Pant Hospital, New Delhi, India
| | | | - Devesh Prakash Yadav
- Department of Gastroenterology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - Sudhir Maharshi
- Department of Gastroenterology, SMS Medical College, Jaipur, Rajasthan, India
| | - Sandeep V. Nair
- Department of Gastroenterology, Amrita Institute of Medical Sciences, Kochi, Kerala, India
| | - Ashok Dalal
- Department of Gastroenterology, GB Pant Hospital, New Delhi, India
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20
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Jain A, Sharma BC, Mahajan B, Srivastava S, Kumar A, Sachdeva S, Sonika U, Dalal A. L-ornithine L-aspartate in acute treatment of severe hepatic encephalopathy: A double-blind randomized controlled trial. Hepatology 2022; 75:1194-1203. [PMID: 34822189 DOI: 10.1002/hep.32255] [Citation(s) in RCA: 35] [Impact Index Per Article: 17.5] [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] [Received: 05/29/2021] [Revised: 11/13/2021] [Accepted: 11/18/2021] [Indexed: 02/06/2023]
Abstract
BACKGROUND AND AIMS Data on the use of intravenous L-ornithine L-aspartate (LOLA) in the treatment of overt HE (OHE) is limited. We evaluated the role of intravenous LOLA in patients of cirrhosis with OHE grade III-IV. APPROACH AND RESULTS In a double-blind randomized placebo-controlled trial, 140 patients were randomized to a combination of LOLA, lactulose, and rifaximin (n = 70) or placebo, lactulose, and rifaximin (n = 70). LOLA was given as continuous intravenous infusion at a dose of 30 g over 24 h for 5 days. Ammonia levels, TNF-α, ILs, and endotoxins were measured on days 0 and 5. The primary outcome was the improvement in the grade of HE at day 5. Higher rates of improvement in grade of HE (92.5% vs. 66%, p < 0.001), lower time to recovery (2.70 ± 0.46 vs. 3.00 ± 0.87 days, p = 0.03), and lower 28-day mortality (16.4% vs. 41.8%, p = 0.001) were seen in the LOLA group as compared with placebo. Levels of inflammatory markers were reduced in both groups. Significantly higher reductions in levels of blood ammonia, IL-6, and TNF-α were seen in the LOLA group. CONCLUSIONS Combination of LOLA with lactulose and rifaximin was more effective than only lactulose and rifaximin in improving grades of HE, recovery time from encephalopathy, with lower 28-day mortality.
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Affiliation(s)
- Arpan Jain
- Department of GastroenterologyGB Pant HospitalNew DelhiIndia
| | | | - Bhawna Mahajan
- Department of BiochemistryGB Pant HospitalNew DelhiIndia
| | | | - Ajay Kumar
- Department of GastroenterologyGB Pant HospitalNew DelhiIndia
| | | | - Ujjwal Sonika
- Department of GastroenterologyGB Pant HospitalNew DelhiIndia
| | - Ashok Dalal
- Department of GastroenterologyGB Pant HospitalNew DelhiIndia
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21
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Sachdeva S, Dalal A, Sonika U, Srivastava S. Mediastinal dumbbell pancreatic pseudocyst: An amazing cause of dysphagia. Dig Liver Dis 2022; 54:413-414. [PMID: 33139194 DOI: 10.1016/j.dld.2020.10.008] [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] [Received: 10/09/2020] [Accepted: 10/11/2020] [Indexed: 12/11/2022]
Affiliation(s)
- Sanjeev Sachdeva
- Department of Gastroenterology, GB Pant Hospital, New Delhi, India.
| | - Ashok Dalal
- Department of Gastroenterology, GB Pant Hospital, New Delhi, India
| | - Ujjwal Sonika
- Department of Gastroenterology, GB Pant Hospital, New Delhi, India
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22
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Sethi SS, Sachdeva S, Puri AS. Casal's Necklace: Extraintestinal Manifestation of Tropical Sprue. Clin Gastroenterol Hepatol 2022; 20:e349-e350. [PMID: 33440253 DOI: 10.1016/j.cgh.2021.01.013] [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] [Received: 12/13/2020] [Revised: 01/04/2021] [Accepted: 01/07/2021] [Indexed: 02/07/2023]
Affiliation(s)
| | - Sanjeev Sachdeva
- Department of Gastroenterology, GB Pant Hospital, New Delhi, India
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23
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Mishra A, Puri AS, Sachdeva S, Dalal A. Efficacy of hepatitis B vaccination in patients with ulcerative colitis: a prospective cohort study. Intest Res 2022; 20:445-451. [PMID: 35124949 DOI: 10.5217/ir.2021.00106] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 10/08/2021] [Indexed: 11/05/2022] Open
Abstract
Background/Aims Response to vaccine in patients with inflammatory bowel disease is lower than in the general population. We aimed to evaluate the efficacy of hepatitis B virus (HBV) vaccination in patients with ulcerative colitis (UC) versus controls. Methods We prospectively compared antibody response to HBV vaccination in 100 patients with UC versus controls. HBV vaccination was given to all the cases and controls at 0, 1 and 6 months. Anti-hepatitis B surface (anti-HBs) titers were then measured 4 weeks after the first and the third dose. Adequate immune response (AIR) was considered if the anti-HBs titer was >10 IU/L and effective immune response (EIR) if the anti-HBs titer was >100 IU/L. Results Median anti-HBs titer was lower in patients with UC than controls (67 IU/L vs. 105 IU/L, P<0.01). AIR and EIR were significantly lower in patients than in controls (82% vs. 96%, P=0.001; 41% vs. 66%, P<0.001, respectively). Univariate analysis showed that age <30 years, mild to moderate severity of disease, disease duration <5 years, male sex, post first dose anti-HBs titer >2 IU/L and non-exposure to corticosteroids, azathioprine and biologicals were predictors of AIR in patients with UC (P<0.05). Multivariate analysis revealed that only non-exposure to corticosteroids, azathioprine and biologicals, male sex, and disease duration <5 years were independent predictors of AIR. Conclusions Response rate to the HBV vaccination in patients with UC was significantly lower as compared to the controls. Male sex, shorter disease duration, and non-exposure to immunomodulators were independent predictors of AIR.
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Affiliation(s)
- Anurag Mishra
- Department of Gastroenterology, Govind Ballabh Pant Institute of Postgraduate Medical Education and Research (GIPMER), New Delhi, India
| | - Amarender Singh Puri
- Department of Gastroenterology, Govind Ballabh Pant Institute of Postgraduate Medical Education and Research (GIPMER), New Delhi, India
| | - Sanjeev Sachdeva
- Department of Gastroenterology, Govind Ballabh Pant Institute of Postgraduate Medical Education and Research (GIPMER), New Delhi, India
| | - Ashok Dalal
- Department of Gastroenterology, Govind Ballabh Pant Institute of Postgraduate Medical Education and Research (GIPMER), New Delhi, India
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24
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Verma A, Girish MI, Dahale AS, Dalal A, Sachdeva S. CMV Colitis in Immunocompetent Patients—A Case Series. Journal of Digestive Endoscopy 2022. [DOI: 10.1055/s-0041-1742134] [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: 10/19/2022] Open
Affiliation(s)
- Anushka Verma
- Department of Physiology, Lady Hardinge Medical College, New Delhi, India
| | - Muppa Indrakeela Girish
- Department of Gastroenterology and Hepatology, DY Patil Medical College, Pune, Maharashtra, India
| | - Amol S. Dahale
- Department of Gastroenterology and Hepatology, DY Patil Medical College, Pune, Maharashtra, India
| | - Ashok Dalal
- Department of Gastroenterology and Hepatology, Govind Ballabh Pant Institute of Postgraduate Medical Education and Research, New Delhi, India
| | - Sanjeev Sachdeva
- Department of Gastroenterology and Hepatology, Govind Ballabh Pant Institute of Postgraduate Medical Education and Research, New Delhi, India
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25
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Kumar M, George R, Vaithiyam V, Sakhuja P, Dahale AS, Dayal A, Dalal A, Sonika U, Sachdeva S, Kumar A. Enhanced Liver Fibrosis Score: Is It Useful for Evaluation of Fibrosis Severity in Chronic Hepatitis C Infection? Cureus 2022; 14:e21168. [PMID: 35165618 PMCID: PMC8831389 DOI: 10.7759/cureus.21168] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/12/2022] [Indexed: 11/05/2022] Open
Abstract
Introduction: The assessment of liver fibrosis is important in patients with chronic hepatitis C (CHC). In recent years, non-invasive tests like enhanced liver fibrosis (ELF) have been developed as an alternative to liver biopsy for estimating the severity of liver fibrosis. Therefore, we aimed to assess whether the ELF score can be used for fibrosis severity estimation using liver biopsy as the gold standard. Materials and methods: Forty-nine patients with CHC were enrolled in this study. Liver biopsy, ELF assessment, and transient elastography (TE) were performed in all patients, and severity of fibrosis on histopathology was assessed by meta-analysis of histological data in viral hepatitis (METAVIR) score. In addition, the diagnostic performance of ELF was evaluated by receiver operator characteristic curve (ROC) analyses, and liver biopsy histopathology was taken as the gold standard for the severity of liver fibrosis. Results: The area under receiver operator characteristic curve (AUROC) for significant fibrosis of ELF score was 0.64 (95% confidence interval {CI}, 0.48-0.79) and of TE was 0.85 (95% CI, 0.73-0.96). The AUROC for advance fibrosis of ELF was 0.77 (95% CI, 0.57-0.97) and TE was 0.98 (95% CI, 0.94-1.0). The calculated cut-offs of ELF overestimated fibrosis in 53.06% (26/49) of patients and underestimated fibrosis in 6.12% (3/49) patients. AUROC of TE was significantly better than ELF for diagnosis of significant fibrosis (p=0.004) and advanced fibrosis (p=0.034). Conclusion: The ELF score can be used for estimating the severity of fibrosis but it is inferior to TE in estimating liver fibrosis severity.
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Ghoshal UC, Sachdeva S, Ghoshal U, Misra A, Puri AS, Pratap N, Shah A, Rahman MM, Gwee KA, Tan VPY, Ahmed T, Lee YY, Ramakrishna BS, Talukdar R, Rana SV, Sinha SK, Chen M, Kim N, Holtmann G. Asian-Pacific consensus on small intestinal bacterial overgrowth in gastrointestinal disorders: An initiative of the Indian Neurogastroenterology and Motility Association. Indian J Gastroenterol 2022; 41:483-507. [PMID: 36214973 PMCID: PMC9549446 DOI: 10.1007/s12664-022-01292-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [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: 06/20/2022] [Accepted: 08/02/2022] [Indexed: 02/04/2023]
Abstract
In the clinical setting, small intestinal bacterial overgrowth (SIBO) is a frequent, but under-diagnosed entity. SIBO is linked to various gastrointestinal (GI) and non-GI disorders with potentially significant morbidity. The optimal management of SIBO is undefined while there is a lack of published consensus guidelines. Against this background, under the auspices of the Indian Neurogastroenterology and Motility Association (INMA), formerly known as the Indian Motility and Functional Diseases Association (IMFDA), experts from the Asian-Pacific region with extensive research and clinical experience in the field of gut dysbiosis including SIBO developed this evidence-based practice guideline for the management of SIBO utilizing a modified Delphi process based upon 37 consensus statements, involving an electronic voting process as well as face-to-face meetings and review of relevant supporting literature. These statements include 6 statements on definition and epidemiology; 11 on etiopathogenesis and pathophysiology; 5 on clinical manifestations, differential diagnosis, and predictors; and 15 on investigations and treatment. When the proportion of those who voted either to accept completely or with minor reservations was 80% or higher, the statement was regarded as accepted. The members of the consensus team consider that this guideline would be valuable to inform clinical practice, teaching, and research on SIBO in the Asian-Pacific region as well as in other countries.
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Affiliation(s)
- Uday C. Ghoshal
- Department of Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, 226 014 India
| | - Sanjeev Sachdeva
- Department of Gastroenterology, G B Pant Hospital, New Delhi, 110 002 India
| | - Ujjala Ghoshal
- Department of Microbiology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, 226 014 India
| | - Asha Misra
- Department of Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, 226 014 India
| | | | | | - Ayesha Shah
- University of Queensland, Faculty of Medicine, and Princess Alexandra Hospital, Department of Gastroenterology and Hepatology, Brisbane, Queensland, Australia
| | - M. Masudur Rahman
- Sheikh Russel National Gastroliver Institute and Hospital, Dhaka, Bangladesh
| | - Kok Ann Gwee
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore ,Stomach, Liver and Bowel Centre, Gleneagles Hospital, Singapore, Singapore
| | - Victoria P Y Tan
- Faculty of Medicine, University of Hong Kong, Pok Fu Lam, Hong Kong
| | - Tahmeed Ahmed
- International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Yeong Yeh Lee
- School of Medical Sciences, Universiti Sains Malaysia, Kota Bharu, Malaysia ,GI Function and Motility Unit, Hospital Universiti Sains Malaysia, Kota Bharu, Malaysia
| | - B S Ramakrishna
- SIMS Institute of Gastroenterology, Hepatology, and Transplantation, SRM Institutes for Medical Science, Chennai, 600 026 India
| | - Rupjyoti Talukdar
- Department of Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, 500 082 India
| | - S V Rana
- Department of Biochemistry, All India Institute of Medical Sciences, Rishikesh, 249 203 India
| | - Saroj K Sinha
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, 160 012 India
| | - Minhu Chen
- Department of Gastroenterology and Hepatology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Nayoung Kim
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seoul, South Korea
| | - Gerald Holtmann
- University of Queensland, Faculty of Medicine, and Princess Alexandra Hospital, Department of Gastroenterology and Hepatology, Brisbane, Queensland, Australia
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Dahale AS, Puri AS, Verma A, Sachdeva S, Dalal A, Banerjee D. Extrapulmonary Tuberculosis in Cirrhosis: Too Familiar-Too Much Unknown. J Clin Exp Hepatol 2022; 12:1021-1022. [PMID: 35677517 PMCID: PMC9168710 DOI: 10.1016/j.jceh.2021.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Accepted: 12/05/2021] [Indexed: 12/12/2022] Open
Key Words
- ADA, adenosine deaminase
- DILI, drug-induced liver injury
- E, ethambutol
- EPTB, extrapulmonary tuberculosis
- H, isoniazid
- L, levofloxacin
- NASH, nonalcoholic steatohepatitis
- R, rifampicin
- S, streptomycin
- SAAG, serum-ascites albumin gradient
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Affiliation(s)
- Amol S. Dahale
- Address for correspondence: Amol S. Dahale, Department of Medical Gastroenterology, Dr DY Patil Medical College, Pune, India.
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Dalal A, Dahale A, Gupta M, Saxena P, Kumar A, Sonika U, Kumar M, Srivastava S, Sachdeva S, Sharma B, Puri A. Endoscopic retrograde cholangiopancreaticography-related complications – Experience from tertiary care teaching centre over half a decade. J Minim Access Surg 2022; 18:526-532. [PMID: 35046182 PMCID: PMC9632712 DOI: 10.4103/jmas.jmas_272_21] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Introduction: Endoscopic retrograde cholangiopancreaticography (ERCP) is an essential therapeutic procedure with a significant risk of complications. Data regarding the complications and predictors of adverse outcomes such as mortality are scarce, especially from India and Asia. We aimed to look at the incidence and outcome of complications in ERCP patients. Materials and Methods: This study is a retrospective analysis of prospectively collected data of all the patients who underwent ERCP and had a complication from January 2012 to December 2018. Data were recorded in predesigned pro forma. The data analysis was done by appropriate statistical tests. RESULTS: A total of 17,163 ERCP were done. A total of 570 patients (3.3%) had complications; perforation (n = 275, 1.6%) was most common followed by pancreatitis (n = 177, 1.03%) and bleeding (n = 60, 0.35%). The majorities of perforations were managed conservatively (n = 205, 74.5%), and 53 (19%) required surgery. Overall, 69 (0.4%) patients died. Of these, 30 (10.9%) patients died with perforation. Age (odds ratio [OR]: 1.04, 95% confidence interval [CI]: 1.005–1.07) and need of surgery (OR: 5.11, 95% CI: 1.66–15.77) were the predictors of mortality in patients with perforation. The majority pancreatitis were mild (n = 125, 70.6%) and overall mortality was 5.6% (n = 10). Conclusion: ERCP complications have been remained static over the years, with perforation and pancreatitis contributing the most. Most perforations can be managed conservatively with good clinical outcomes.
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Sud S, Sachdeva S, Puri AS. Tacrolimus as rescue therapy for steroid-dependent/steroid-refractory ulcerative colitis: Experience from tertiary referral center in India. Indian J Gastroenterol 2021; 40:598-603. [PMID: 34971402 DOI: 10.1007/s12664-021-01185-5] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Accepted: 04/19/2021] [Indexed: 02/06/2023]
Abstract
INTRODUCTION Between 20% and 40% of patients with severe ulcerative colitis (UC) are either steroid-refractory UC (SRUC) or steroid-dependent UC (SDUC). Tacrolimus is an oral and relatively inexpensive drug, which has been extensively used in Japan for steroid-refractory and steroid-dependent disease. METHODS Patients diagnosed with SDUC/SRUC were treated with tacrolimus 0.05-0.1 mg/kg in this prospective study. Clinical Mayo score (CMS) and UC Endoscopic Index of Severity (UCEIS) were evaluated prior to starting the drug and subsequently after 8 weeks. 5-Aminosalicylic acid agents (5-ASA) and immunomodulators were continued if the patients were previously on these drugs. Clinical response at 8 weeks was defined as decrease in CMS by at least 3 points. Clinical remission was defined as CMS ≤2 and combined remission as CMS≤2 with UCEIS <3. RESULTS Fifty-two patients (29 males) with a mean age of 35.1± 12.8 years with predominantly E3 disease (71%) were prospectively evaluated in this study. SDUC and SRUC were diagnosed in 31 and 21 patients, respectively. Seven failed treatment within 8 weeks, four were subjected to surgery, and 3 were switched to infliximab. Forty-two patients continued tacrolimus for 8 weeks. Mean CMS and UCEIS prior to starting tacrolimus were 6 ± 1.1 and 4.8 ± 1.1, respectively. At 8 weeks, median CMS and UCEIS decreased to 2.6 ± 1.7 and 2.7 ± 1.3, respectively. Clinical response was documented in 29 patients (56%) at week 8 whereas clinical remission was seen in 25 patients (48%). Combined clinical and endoscopic remissions were seen in 18 patients (35%). Except for a single patient who developed reversible renal dysfunction, no other adverse event was observed. CONCLUSION Our results show that tacrolimus is effective in inducing a clinical response in 56% of patients with SDUC and SRUC. In view of its low cost and safety profile, it may be considered first-line therapy for SDUC/SRUC.
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Affiliation(s)
- Sukrit Sud
- Department of Gastroenterology, G B Pant Institute of Postgraduate Medical Education and Research, New Delhi 110 002, India. .,Medanta -The Medicity Hospital, Gurugram, 122 006, India.
| | - Sanjeev Sachdeva
- Department of Gastroenterology, G B Pant Institute of Postgraduate Medical Education and Research, New Delhi 110 002, India.,Medanta -The Medicity Hospital, Gurugram, 122 006, India
| | - Amarender Singh Puri
- Department of Gastroenterology, G B Pant Institute of Postgraduate Medical Education and Research, New Delhi 110 002, India.,Medanta -The Medicity Hospital, Gurugram, 122 006, India
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Sachdeva S, Dalal A, Dahale AS, Sonika U. Triple-A Syndrome: A rare cause of pediatric achalasia. Dig Liver Dis 2021; 53:1352-1353. [PMID: 32900647 DOI: 10.1016/j.dld.2020.08.026] [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: 07/29/2020] [Revised: 08/15/2020] [Accepted: 08/20/2020] [Indexed: 12/11/2022]
Affiliation(s)
- Sanjeev Sachdeva
- Department of Gastroenterology, GB Pant Hospital, New Delhi 110002, India.
| | - Ashok Dalal
- Department of Gastroenterology, GB Pant Hospital, New Delhi 110002, India
| | - Amol S Dahale
- Department of Gastroenterology, GB Pant Hospital, New Delhi 110002, India
| | - Ujjwal Sonika
- Department of Gastroenterology, GB Pant Hospital, New Delhi 110002, India
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Dahale AS, Puri AS, Sachdeva S, Agarwal AK, Kumar A, Dalal A, Saxena PD. Reappraisal of the Role of Ascitic Fluid Adenosine Deaminase for the Diagnosis of Peritoneal Tuberculosis in Cirrhosis. Korean J Gastroenterol 2021; 78:168-176. [PMID: 34565786 DOI: 10.4166/kjg.2021.068] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 07/24/2021] [Accepted: 07/26/2021] [Indexed: 11/03/2022]
Abstract
Backgrounds/Aims Although peritoneal tuberculosis (TB) is one of the important differential diagnoses among cirrhotic patients with ascites, a peritoneal biopsy is not always available. High ascitic fluid adenosine deaminase (ADA) has been indicative of peritoneal TB. On the other hand, studies to assess its diagnostic utility based on the confirmation of peritoneal biopsy in cirrhotic patients are scarce. Methods Patients with new-onset ascites were enrolled prospectively from a tertiary hospital. Peritoneal biopsy was applied according to clinical judgment when required. Based on pathology diagnosis of the peritoneum, the diagnostic efficacy of ascitic fluid ADA for peritoneal TB was evaluated in total and cirrhotic patients, respectively. Results Among 286 patients enrolled, 78 were diagnosed with peritoneal TB. One hundred and thirty-two patients had cirrhosis, and 30 of those were diagnosed with peritoneal TB. The mean ADA was 72.2 U/L and 22.7 U/L in the peritoneal and non-peritoneal TB group, respectively, among the total study population, and 64.0 U/L and 19.1 U/L in the peritoneal and non-peritoneal TB group, respectively, among the subgroup with cirrhosis. The area under the curve for ADA to diagnose peritoneal TB was 0.96 in the total study population with a cutoff value of 41.1 U/L, and 0.93 in cirrhotic patients with a cutoff value of 39.9 U/L. Conclusions The ascitic fluid ADA measurements showed high diagnostic performance for peritoneal tuberculosis in patients with ascites regardless of cirrhosis at a similar cutoff value.
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Affiliation(s)
| | - Amarender Singh Puri
- Department of Gastroenterology, G. B. Pant Institute of Postgraduate Medical Education and Research (GIPMER), New Delhi, India
| | - Sanjeev Sachdeva
- Department of Gastroenterology, G. B. Pant Institute of Postgraduate Medical Education and Research (GIPMER), New Delhi, India
| | - Anil K Agarwal
- Department of Gastrointestinal Surgery, G. B. Pant Institute of Postgraduate Medical Education and Research (GIPMER), New Delhi, India
| | - Ajay Kumar
- Department of Gastroenterology, G. B. Pant Institute of Postgraduate Medical Education and Research (GIPMER), New Delhi, India
| | - Ashok Dalal
- Department of Gastroenterology, G. B. Pant Institute of Postgraduate Medical Education and Research (GIPMER), New Delhi, India
| | - Pritul D Saxena
- Department of Gastroenterology, G. B. Pant Institute of Postgraduate Medical Education and Research (GIPMER), New Delhi, India
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Dalal A, Kumar A, Arivarasan K, Dahale A, Sachdeva S, Sonika U, Pawar A. Colonic Stenting Using Side-Viewing Endoscope: A Case Report. Journal of Digestive Endoscopy 2021. [DOI: 10.1055/s-0040-1713833] [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: 10/20/2022] Open
Abstract
AbstractColonic self-expandable metal stents (SEMS) are widely used as palliation for malignant obstruction. The conventional method involves using a forward-viewing endoscope as part of the procedure. Sometimes, however, the sharp angle of the stricture poses difficulty in evaluating the stricture, so a guidewire is placed across the stricture. Here, we present a case where a side-viewing endoscope was employed for colonic stent placement and propose its use in patients with sharp bends to increase success.
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Affiliation(s)
- Ashok Dalal
- Department of Gastroenterology, GB Pant Hospital, New Delhi, India
| | - Ajay Kumar
- Department of Gastroenterology, GB Pant Hospital, New Delhi, India
| | - K Arivarasan
- Department of Gastroenterology, GB Pant Hospital, New Delhi, India
| | - Amol Dahale
- Department of Gastroenterology, GB Pant Hospital, New Delhi, India
| | - Sanjeev Sachdeva
- Department of Gastroenterology, GB Pant Hospital, New Delhi, India
| | - Ujjwal Sonika
- Department of Gastroenterology, GB Pant Hospital, New Delhi, India
| | - Ankush Pawar
- Department of Gastroenterology, GB Pant Hospital, New Delhi, India
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Jagannath S, Agarwal A, Gunjan D, Mohindra S, Sharma V, Chowdhury SD, Sachdeva S, Saraswat VA, Kochhar R, Saraya A. Mandatory preprocedure testing for SARS-CoV-2 for all-comers may not be required for resuming endoscopic services amidst the ongoing COVID-19 pandemic. Gut 2021; 70:1805-1806. [PMID: 33158980 DOI: 10.1136/gutjnl-2020-323154] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 10/26/2020] [Accepted: 10/26/2020] [Indexed: 12/27/2022]
Affiliation(s)
- Soumya Jagannath
- Department of Gastroenterology and Human Nutrition, All India Institute of Medical Sciences, New Delhi, Delhi, India
| | - Ashish Agarwal
- Department of Gastroenterology and Human Nutrition, All India Institute of Medical Sciences, New Delhi, Delhi, India
| | - Deepak Gunjan
- Department of Gastroenterology and Human Nutrition, All India Institute of Medical Sciences, New Delhi, Delhi, India
| | - Samir Mohindra
- Gastroenterology, SGPGIMS, Lucknow, Uttar Pradesh, India
| | - Vishal Sharma
- Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | | | | | - Vivek A Saraswat
- Gastroenterology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Rakesh Kochhar
- Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Anoop Saraya
- Department of Gastroenterology and Human Nutrition, All India Institute of Medical Sciences, New Delhi, Delhi, India
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Sachdeva S, Singh AK, Kumar M, George R. Jackhammer esophagus: Rare cause of esophageal diverticulum. Dig Liver Dis 2021; 53:1051-1052. [PMID: 32819860 DOI: 10.1016/j.dld.2020.07.024] [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: 07/01/2020] [Revised: 07/21/2020] [Accepted: 07/22/2020] [Indexed: 12/11/2022]
Affiliation(s)
- Sanjeev Sachdeva
- Department of Gastroenterology, GB Pant Hospital, New Delhi (India)-110002.
| | - Alok Kumar Singh
- Department of Gastroenterology, GB Pant Hospital, New Delhi (India)-110002
| | - Manish Kumar
- Department of Gastroenterology, GB Pant Hospital, New Delhi (India)-110002
| | - Roshan George
- Department of Gastroenterology, GB Pant Hospital, New Delhi (India)-110002
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Kumar M, Sachdeva S, Kumar A, Sonika U, Gupta M, Srivastava S, Dahale A, Dalal A. Gastric Foreign Bodies in Prison Inmates. Journal of Digestive Endoscopy 2021. [DOI: 10.1055/s-0041-1731963] [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: 10/20/2022] Open
Abstract
Abstract
Objective Gastric foreign bodies are a common problem brought to an endoscopist. Prisoners are more prone to ingesting unusual foreign bodies for a secondary gain. The objective of this study was to study the profile of foreign body ingestion among the prisoners brought to a tertiary care center.
Methods This is a retrospective case series. All the prisoners brought for endoscopic removal of foreign bodies between January 2018 to December 2019 were included in the analysis. Patients’ baseline characteristics, type of foreign body, management, and outcome were noted
Results A total of eight inmates presented with ingestion of foreign body to our department. Most common foreign bodies ingested were drug packets and mobile phones. All ingestions were for secondary gain. Endoscopic removal was successful in all cases.
Conclusion Endoscopic removal can be tried with all necessary precautions by an expert endoscopist.
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Affiliation(s)
- Manish Kumar
- Department of Gastroenterology, GB Pant Hospital, New Delhi, India
| | - Sanjeev Sachdeva
- Department of Gastroenterology, GB Pant Hospital, New Delhi, India
| | - Ajay Kumar
- Department of Gastroenterology, GB Pant Hospital, New Delhi, India
| | - Ujjwal Sonika
- Department of Gastroenterology, GB Pant Hospital, New Delhi, India
| | - Manish Gupta
- Department of Gastroenterology, GB Pant Hospital, New Delhi, India
| | | | - Amol Dahale
- Department of Gastroenterology, GB Pant Hospital, New Delhi, India
| | - Ashok Dalal
- Department of Gastroenterology, GB Pant Hospital, New Delhi, India
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Sardana K, Mathachan SR, Sachdeva S, Khurana A. Is there a rationale for the use of voriconazole in dermatophytosis in the absence of mycological and mutational data? An urgent need for antifungal stewardship. Clin Exp Dermatol 2021; 46:1621-1623. [PMID: 34189762 DOI: 10.1111/ced.14824] [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] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/29/2021] [Indexed: 11/27/2022]
Affiliation(s)
- K Sardana
- Department of Dermatology, Venereology and Leprosy, ABVIMS and Dr Ram Manohar Lohia Hospital, New Delhi, India
| | - S R Mathachan
- Department of Dermatology, Venereology and Leprosy, ABVIMS and Dr Ram Manohar Lohia Hospital, New Delhi, India
| | - S Sachdeva
- Department of Dermatology, Venereology and Leprosy, ABVIMS and Dr Ram Manohar Lohia Hospital, New Delhi, India
| | - A Khurana
- Department of Dermatology, Venereology and Leprosy, ABVIMS and Dr Ram Manohar Lohia Hospital, New Delhi, India
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Saluja SS, Varshney VK, Bhat VS, Nekarakanti PK, Arora A, Sachdeva S, Mishra PK. Management of Obscurely Dilated Common Bile Duct with Normal Liver Function Tests: A Pragmatic Approach. World J Surg 2021; 45:2712-2718. [PMID: 34095958 DOI: 10.1007/s00268-021-06175-4] [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] [Subscribe] [Scholar Register] [Accepted: 05/02/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE Dilated common bile duct (CBD) (8-15 mm) with normal liver function tests is seen not infrequently, while management of such patients is ambiguous. We propose a treatment algorithm for this cohort of patients after observing them over a period of 8 years. METHODS Seventy-eight such patients were managed from 2009 to 2017 and categorized as: Group A-dilated CBD with post-cholecystectomy status (n = 15); B-dilated CBD with cholelithiasis (n = 34); C-dilated CBD without cholelithiasis (n = 16); D-dilated CBD with no cause identified and underwent CBD excision (n = 13). Causes for CBD dilatation were evaluated. The outcome of patients in Group B + C without any cause (n = 33) was compared with Group D. RESULT Median age, CBD diameter, bilirubin and alkaline phosphatase were 51 years (13-79), 10 mm (8-20), 0.6 mg/dl (0.2-2.5) and 126 IU (60-214), respectively. Group-A patients who did not manifest any cause of CBD dilatation were managed conservatively. The aetiology was identified in 17/50 patients in Group B & C [acute pancreatitis (n = 6), passed CBD calculi (n = 3), perivaterian diverticulum (n = 3), viral aetiology (n = 4) and tumour (n-1)]. In Group-C, 7 patients with no obvious cause underwent endoscopic sphincterotomy, pancreatoduodenectomy (n = 1), and the rest were managed conservatively (n = 8). There was no significant difference in the complication between Group B + C (without any cause) and Group D (3/33 vs. 1/13; p = 0.58) at a median follow-up of 72 months (30-90). CONCLUSION Dilated CBD with normal LFT's without apparent cause is mostly benign and of no consequence. Excision of the CBD is not required for most of these patients.
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Affiliation(s)
- Sundeep Singh Saluja
- Department of Gastrointestinal Surgery, G B Pant Institute of Post Graduate Medical Education and Research, 1, Jawaharlal Nehru Marg, New Delhi, 110002, India.
| | - Vaibhav Kumar Varshney
- Department of Gastrointestinal Surgery, G B Pant Institute of Post Graduate Medical Education and Research, 1, Jawaharlal Nehru Marg, New Delhi, 110002, India
| | - Vidya Sharada Bhat
- Department of Gastrointestinal Surgery, G B Pant Institute of Post Graduate Medical Education and Research, 1, Jawaharlal Nehru Marg, New Delhi, 110002, India
| | - Phani Kumar Nekarakanti
- Department of Gastrointestinal Surgery, G B Pant Institute of Post Graduate Medical Education and Research, 1, Jawaharlal Nehru Marg, New Delhi, 110002, India
| | - Asit Arora
- Department of Gastrointestinal Surgery, G B Pant Institute of Post Graduate Medical Education and Research, 1, Jawaharlal Nehru Marg, New Delhi, 110002, India
| | - Sanjeev Sachdeva
- Department of Gastroenterology, G B Pant Institute of Post Graduate Medical Education and Research, New Delhi, 110002, India
| | - Pramod Kumar Mishra
- Department of Gastrointestinal Surgery, G B Pant Institute of Post Graduate Medical Education and Research, 1, Jawaharlal Nehru Marg, New Delhi, 110002, India
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Sachdeva S, Jain A, Dalal A, Puri A. Primary Esophageal Lymphoma: A Rare Entity. GE Port J Gastroenterol 2021; 29:366-368. [PMID: 36159195 PMCID: PMC9485927 DOI: 10.1159/000515840] [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] [Figures] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 02/25/2021] [Indexed: 12/15/2022]
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Padia G, Mahajan B, Kumar A, Sonika U, Dahale AS, Sachdeva S, Dalal A, George R. Cystatin C and interleukin-6 for prognosticating patients with acute decompensation of cirrhosis. JGH Open 2021; 5:459-464. [PMID: 33860096 PMCID: PMC8035439 DOI: 10.1002/jgh3.12516] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 02/02/2021] [Accepted: 02/08/2021] [Indexed: 11/10/2022]
Abstract
Background and Aim Systemic inflammation and organ dysfunction/failure can complicate acute decompensation (AD) of cirrhosis with progression to acute‐on‐chronic liver failure (ACLF), leading to increased mortality. There are few studies on serum biomarkers predicting renal dysfunction (RD) or ACLF in AD. Serum cystatin C (CysC) and interleukin‐6 (IL‐6) were evaluated for predicting RD, ACLF, and mortality in AD patients. Methods Consecutive AD patients seen from January 2018 to June 2019 were included. IL‐6 and CysC were measured in serum at the time of index presentation. Patients were followed for 90 days or until primary (development of RD) or secondary outcomes (development of ACLF or mortality). Multivariate analysis was performed to find whether CysC and IL‐6 can independently predict primary and secondary outcomes. Results A total of 124 patients were screened; 88 patients were included. On follow up, 22 (27.3%) developed RD, 11 (11/57, 19.3%) developed ACLF, and 21 (24%) died. The CysC predicted RD (odds ratio [OR] 7.97, 95% confidence interval [CI] 2.70–23.53, P = 0.001) and ACLF (OR 5.486, 95% CI 1.456–20.6, P = 0.012) development. IL‐6 was not an independent predictor of RD (P = 0.315), ACLF (P = 0.168), and mortality (P = 0.225). Conclusion Serum CysC can predict the development of RD and ACLF in patients of cirrhosis with AD.
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Affiliation(s)
- Gaurav Padia
- Department of Gastroenterology G B Pant Institute of Postgraduate Medical Education and Research (GIPMER) New Delhi India
| | - Bhawana Mahajan
- Department of Biochemistry G B Pant Institute of Postgraduate Medical Education and Research (GIPMER) New Delhi India
| | - Ajay Kumar
- Department of Gastroenterology G B Pant Institute of Postgraduate Medical Education and Research (GIPMER) New Delhi India
| | - Ujjwal Sonika
- Department of Gastroenterology G B Pant Institute of Postgraduate Medical Education and Research (GIPMER) New Delhi India
| | - Amol S Dahale
- Department of Gastroenterology G B Pant Institute of Postgraduate Medical Education and Research (GIPMER) New Delhi India
| | - Sanjeev Sachdeva
- Department of Gastroenterology G B Pant Institute of Postgraduate Medical Education and Research (GIPMER) New Delhi India
| | - Ashok Dalal
- Department of Gastroenterology G B Pant Institute of Postgraduate Medical Education and Research (GIPMER) New Delhi India
| | - Roshan George
- Department of Gastroenterology G B Pant Institute of Postgraduate Medical Education and Research (GIPMER) New Delhi India
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Dalal A, Sonika U, Kumar M, George R, Kumar A, Srivastava S, Sachdeva S, Sharma BC. COVID-19 Rapid Antigen Test: Role in Screening Prior to Gastrointestinal Endoscopy. Clin Endosc 2021; 54:522-525. [PMID: 33657784 PMCID: PMC8357579 DOI: 10.5946/ce.2020.295] [Citation(s) in RCA: 6] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2020] [Accepted: 12/23/2020] [Indexed: 01/27/2023] Open
Abstract
Background/Aims The severe acute respiratory syndrome coronavirus 2 pandemic has affected the gastrointestinal (GI) endoscopy units globally owing to the risk of transmission. We present our data on the use of rapid antigen test (RAT) as a screening tool prior to endoscopy to prevent the transmission of coronavirus disease (COVID-19).
Methods This study was a retrospective analysis of patients who underwent any GI endoscopic procedure from July 2020 to October 2020 at a tertiary referral center in New Delhi, India. All patients underwent screening for COVID-19 using RAT, and endoscopy was performed only when the RAT was negative. The data are presented as numbers and percentages.
Results A total of 3,002 endoscopic procedures were performed during the study period. Only one endoscopic procedure was performed in a COVID-19 positive patient. A total of 53 healthcare workers were involved in conducting these procedures. Only 2 healthcare workers (3.8%) were diagnosed COVID-19 positive, presumably due to community-acquired infection, during this period.
Conclusions The COVID-19 RAT is easily usable as a simple screening tool prior to GI endoscopy during the COVID-19 pandemic.
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Affiliation(s)
- Ashok Dalal
- Department of Gastroenterology, Govind Ballabh Pant Institute of Postgraduate Medical Education and Research (GIPMER), New Delhi, India
| | - Ujjwal Sonika
- Department of Gastroenterology, Govind Ballabh Pant Institute of Postgraduate Medical Education and Research (GIPMER), New Delhi, India
| | - Manish Kumar
- Department of Gastroenterology, Govind Ballabh Pant Institute of Postgraduate Medical Education and Research (GIPMER), New Delhi, India
| | - Roshan George
- Department of Gastroenterology, Govind Ballabh Pant Institute of Postgraduate Medical Education and Research (GIPMER), New Delhi, India
| | - Ajay Kumar
- Department of Gastroenterology, Govind Ballabh Pant Institute of Postgraduate Medical Education and Research (GIPMER), New Delhi, India
| | - Siddharth Srivastava
- Department of Gastroenterology, Govind Ballabh Pant Institute of Postgraduate Medical Education and Research (GIPMER), New Delhi, India
| | - Sanjeev Sachdeva
- Department of Gastroenterology, Govind Ballabh Pant Institute of Postgraduate Medical Education and Research (GIPMER), New Delhi, India
| | - Barjesh Chander Sharma
- Department of Gastroenterology, Govind Ballabh Pant Institute of Postgraduate Medical Education and Research (GIPMER), New Delhi, India
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Sachdeva S, Sahu BK, George R. Primary colonic lymphoma: A rare entity. Dig Liver Dis 2021; 53:249-250. [PMID: 32532608 DOI: 10.1016/j.dld.2020.05.038] [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: 05/18/2020] [Accepted: 05/22/2020] [Indexed: 12/11/2022]
Affiliation(s)
- Sanjeev Sachdeva
- Department of Gastroenterology, GB Pant Hospital, New Delhi 110002, India.
| | - Bimal Kumar Sahu
- Department of Gastroenterology, GB Pant Hospital, New Delhi 110002, India
| | - Roshan George
- Department of Gastroenterology, GB Pant Hospital, New Delhi 110002, India
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Abstract
Intraductal papillary mucinous neoplasms (IPMNs) are mucin-secreting cystic neoplasm of pancreas. They have a malignant potential. They are usually localised to the pancreas but occasionally can involve surrounding structures (1.9%-6.6%), like bile duct and duodenum, and are labelled as IPMN with invasion. Jaundice as a manifestation of IPMN is not common (4.5%). It can present as jaundice as a result of invasion of common bile duct (CBD) resulting in stricture formation or uncommonly as a result of fistulising to CBD with resultant obstruction of CBD by thick mucin secreted by this tumour. As only few cases (around 23) of mucin-filled CBD are reported in the literature. We are presenting our experience in dealing a rare case of obstructive jaundice caused by IPMN fistulising into CBD, highlighting the difficulties faced in managing such case, especially with regards to biliary drainage and what can be the optimum management in such cases.
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Affiliation(s)
- Manish Kumar
- Gastroenterology, GB Pant Hospital, New Delhi, India
| | - Ujjwal Sonika
- Gastroenterology, GB Pant Hospital, New Delhi, India
| | | | - Ashok Dalal
- Gastroenterology, GB Pant Hospital, New Delhi, India
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Sachdeva S, Sethi SS, Kumar A, Dalal A. Choledocholithiasis in autosomal dominant polycystic kidney disease. Dig Liver Dis 2021; 53:127-128. [PMID: 32553703 DOI: 10.1016/j.dld.2020.05.036] [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: 05/14/2020] [Revised: 05/16/2020] [Accepted: 05/18/2020] [Indexed: 12/11/2022]
Affiliation(s)
- Sanjeev Sachdeva
- Department of Gastroenterology, GB Pant Hospital, New Delhi 110002, India.
| | - Sukrit Singh Sethi
- Department of Gastroenterology, GB Pant Hospital, New Delhi 110002, India
| | - Ajay Kumar
- Department of Gastroenterology, GB Pant Hospital, New Delhi 110002, India
| | - Ashok Dalal
- Department of Gastroenterology, GB Pant Hospital, New Delhi 110002, India
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Agarwal A, Chowdhury SD, Sachdeva S, Saraswat V, Kochhar R, Saraya A. Low risk of transmission of SARS-CoV2 and effective endotherapy for gastrointestinal bleeding despite challenges supports resuming optimum endoscopic services. Dig Liver Dis 2021; 53:4-7. [PMID: 33129713 PMCID: PMC7556781 DOI: 10.1016/j.dld.2020.10.009] [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] [Received: 10/08/2020] [Accepted: 10/11/2020] [Indexed: 12/11/2022]
Affiliation(s)
- Ashish Agarwal
- Department of Gastroenterology and Human Nutrition Unit, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, India
| | | | - Sanjeev Sachdeva
- Department of Gastroenterology, Gobind Ballabh Pant Hospital, New Delhi, India
| | - Vivek Saraswat
- Department of Gastroenterology, Sanjay Gandhi Post Graduate Institute, Lucknow, India,Corresponding authors at: For Gastroenterology Alliance of India (GAIN) Study Group
| | - Rakesh Kochhar
- Department of Gastroenterology, Post Graduate Institute of Medical Education and Research, Chandigarh, India,Corresponding authors at: For Gastroenterology Alliance of India (GAIN) Study Group
| | - Anoop Saraya
- Department of Gastroenterology and Human Nutrition Unit, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, India,Corresponding authors at: For Gastroenterology Alliance of India (GAIN) Study Group
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Sachdeva S, Sahu BK, Sonyabapu AD, Dalal A, Sonika U. Abdominal
CT
in a pregnant woman: Bane or boon? JGH Open 2021; 5:155-156. [PMID: 33490628 PMCID: PMC7812491 DOI: 10.1002/jgh3.12471] [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] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Accepted: 11/25/2020] [Indexed: 11/07/2022]
Affiliation(s)
| | - Bimal K Sahu
- Department of Gastroenterology GB Pant Hospital New Delhi India
| | | | - Ashok Dalal
- Department of Gastroenterology GB Pant Hospital New Delhi India
| | - Ujjwal Sonika
- Department of Gastroenterology GB Pant Hospital New Delhi India
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Dahale AS, Srivastava S, Saluja SS, Sachdeva S, Dalal A, Varakanahalli S. Management of scope-induced type I duodenal perforations: Over-the-scope clip versus surgery. Indian J Gastroenterol 2021; 40:287-294. [PMID: 33974228 PMCID: PMC8195754 DOI: 10.1007/s12664-021-01152-0] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 01/18/2021] [Indexed: 02/04/2023]
Abstract
BACKGROUND Scope-induced duodenal perforation is a life-threatening complication and surgery remains the standard of care. With the advent of over-the-scope clip (OTSC), scope-induced perforations are increasingly managed conservatively, though there is no study comparing this form of non-surgical treatment with surgery. We aimed to compare OTSC and surgery in the management of scope-induced perforation of the duodenum. METHODS We retrospectively collected data of scope-induced duodenal perforation patients. Perforations identified and treated within 24 h of procedure were analyzed. Factors analyzed were spectrum, etiology, baseline parameters, perforation size, outcome, comorbidities, and duration of hospital stay. RESULTS A total of 25 patients had type I duodenal perforations, out of whom five were excluded due to delayed diagnosis and treatment. Of the twenty, eight were treated with OTSC placement while the rest underwent surgery. Age was comparable and the majority were females. Baseline parameters and comorbidities were similar in both the groups. The median size of perforation was 1.5 cm in both the OTSC group and the surgical group. All patients were treated with standard of care according to institutional protocols. Patients in the OTSC group were started orally after 48 h of OTSC placement, while in the surgery group median time to oral intake was 7 days. Two patients in the surgical group died while there was no mortality in the OTSC group (p = 0.48). Median hospital stay was shorter in the OTSC group (2 days vs. 22 days, p = 0.003). CONCLUSIONS OTSC is a feasible and better option in type I duodenal perforations with a shorter hospital stay.
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Affiliation(s)
- Amol S. Dahale
- Department of Gastroenterology, Dr. D Y Patil Medical College and Hospital, Pimpri, Pune, 411 018 India
| | - Siddharth Srivastava
- Department of Gastroenterology, G B Pant Institute of Postgraduate Medical Education and Research, 1, J L N Marg, New Delhi, 110 002 India
| | - Sundeep Singh Saluja
- Department of Gastrointestinal Surgery, G B Pant Institute of Postgraduate Medical Education and Research, New Delhi, 110 002 India
| | - Sanjeev Sachdeva
- Department of Gastroenterology, G B Pant Institute of Postgraduate Medical Education and Research, 1, J L N Marg, New Delhi, 110 002 India
| | - Ashok Dalal
- Department of Gastroenterology, G B Pant Institute of Postgraduate Medical Education and Research, 1, J L N Marg, New Delhi, 110 002 India
| | - Shivakumar Varakanahalli
- Department of Gastroenterology, G B Pant Institute of Postgraduate Medical Education and Research, 1, J L N Marg, New Delhi, 110 002 India
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Sethi S, Puri A, Sachdeva S, Dalal A. Erythrophagocytosis in colonic mucosa: real-time amazing display. BMJ Case Rep 2020; 13:13/12/e238921. [PMID: 33310835 PMCID: PMC7735084 DOI: 10.1136/bcr-2020-238921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Affiliation(s)
- Sukrit Sethi
- Gastroenterology, GB Pant Hospital, New Delhi, Delhi, India
| | - Amarender Puri
- Gastroenterology, GB Pant Hospital, New Delhi, Delhi, India
| | | | - Ashok Dalal
- Gastroenterology, GB Pant Hospital, New Delhi, Delhi, India
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Sachdeva S, Dalal A, Kumar A, George R. Multifocal gastric metastasis of malignant melanoma: An ominous endoscopic appearance: Gastric metastasis of malignant melanoma. Dig Liver Dis 2020; 52:1512. [PMID: 32507693 DOI: 10.1016/j.dld.2020.05.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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] [Received: 04/26/2020] [Accepted: 05/08/2020] [Indexed: 12/11/2022]
Affiliation(s)
- Sanjeev Sachdeva
- Department of Gastroenterology, GB Pant Hospital, New Delhi (India)-110002.
| | - Ashok Dalal
- Department of Gastroenterology, GB Pant Hospital, New Delhi (India)-110002
| | - Ajay Kumar
- Department of Gastroenterology, GB Pant Hospital, New Delhi (India)-110002
| | - Roshan George
- Department of Gastroenterology, GB Pant Hospital, New Delhi (India)-110002
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Hanna B, Desai R, Sachdeva S, Singh S, Gangani K, Taha Y, Echols M, Paul T, Berman A, Bloom H, Kumar G, Sachdeva R. Pulmonary artery injury in left atrial appendage closure device implantation: a systematic review of a potentially fatal complication. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.0667] [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: 11/13/2022] Open
Abstract
Abstract
Background
Pulmonary artery (PA) injury is a rarely reported complication following percutaneous left atrial appendage closure (LAAC). This study aims to systematically review all reported cases of PA injury associated with LAAC.
Methods
PubMed/Medline, SCOPUS, EMBASE, Google Scholar and the MAUDE databases were searched to find studies reporting PA injury during or after LAAC with the Amplatzer Amulet (AA), Amplatzer Cardiac Plug (ACP) or Watchman device through October 2019. Categorical data were reported in terms of numbers and/or percentages (%).
Results
We found 13 cases (mean age 71.4 yrs) with reported PA injury associated with LAAC. Of these, 9 were case reports, 3 were reported in observational studies, and 1 was in the MAUDE database. Most cases (n=8) were reported in Europe followed by Australia (n=2) and Asia (n=2). The indication for device implantation in all patients was a high bleeding risk with anticoagulation for atrial fibrillation. Five cases were reported with the ACP (1/5 patients died), 5 with AA (2/5 patients died), and 3 with the Watchman (1/2 patients died). Acute and late presentations following implantation were reported for all three devices. 69.2% of cases (9/13) occurred acutely (during or within 24 hours of intervention). Of these, 3/9 occurred during device implantation. 2/4 of the delayed cases occurred >2 weeks following implantation. The mortality rate for acute and delayed cases was 22% (2/9 patients) and 50% (2/4 patients), respectively. A majority of the cases were attributable to barb/strut/hook injury of the PA. PA injury was associated with a mortality rate of approximately 31%. All surviving patients were managed with surgical intervention.
Conclusion
PA injury is an infrequently reported complication following LAAC and is associated with high mortality. Cases can present acutely (intra-procedurally or within 24 hours) or delayed (>24 hours post-implantation). A majority of cases are due to direct injury of the PA by the struts/hooks/barbs of the device. Practitioners should be cognizant of this life-threatening complication, which requires a high index of suspicion for diagnosis and can occur weeks after device implantation.
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- B Hanna
- Morehouse School of Medicine, Atlanta, United States of America
| | - R Desai
- Atlanta Veterans Affairs Medical Center, Cardiology, Atlanta, United States of America
| | - S Sachdeva
- Lady Hardinge Medical College and Hospitals, Department of Medicine, New Delhi, India
| | - S Singh
- Amsterdam University Medical Center, Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Amsterdam, Netherlands (The)
| | - K Gangani
- Texas Health Arlington Memorial Hospital, Department of Internal Medicine, Arlington, Texas, United States of America
| | - Y Taha
- Morehouse School of Medicine, Atlanta, United States of America
| | - M Echols
- Morehouse School of Medicine, Atlanta, United States of America
| | - T.K Paul
- East Tennessee State University, Division of Cardiology, Johnson city, Tennessee, United States of America
| | - A Berman
- Augusta University, Augusta, United States of America
| | - H Bloom
- Atlanta Veterans Affairs Medical Center, Cardiology, Atlanta, United States of America
| | - G Kumar
- Atlanta Veterans Affairs Medical Center, Cardiology, Atlanta, United States of America
| | - R Sachdeva
- Morehouse School of Medicine, Atlanta, United States of America
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Desai R, Sachdeva S, Singh S, Rajan S, Shaik A, Haider M, Fong H, Gangani K, Sachdeva R, Kumar G. Rates and causes of readmissions following index admissions for Takotsubo syndrome-a meta-analysis of 118,941 index hospitalizations. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.1246] [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: 11/13/2022] Open
Abstract
Abstract
Background
Rising trends in takotsubo syndrome (TTS)-related complications warrant data to identify the rate, causes and predictors of readmission on a large scale. We conducted the first-ever meta-analysis to evaluate the pooled rate of short-term and long-term readmissions after index TTS admissions.
Methods
PubMed/Medline, EMBASE and SCOPUS databases were systematically reviewed to find studies through October 2019 reporting rates and causes of readmission following index TTS admissions. Random effects models were used to estimate pooled rates and causes of readmissions and I2 statistics were used to report inter-study heterogeneity.
Results
A total of 16 cohorts with 118,941 TTS index admissions (mean age 65–75 yrs; female >85%, median follow-up 272.5 days) revealed a 16.6% [95% CI-13.2%-20.3%, I2=99%] pooled rate of readmission. Short-term and long-term pooled readmission rates are displayed in Fig.1. The readmission rate was higher in cohorts with young patients (<70 vs. >70 yrs), smaller sample size (n<100 vs. n>100) and single-centres vs. multicentres. Studies published from the USA (16.4% vs. 14.9%) had a higher readmission rate as compared to Italy. The most frequent causes were cardiac (40.6%), respiratory (15.7%) and renal (7.0%). Among readmissions with cardiac diagnoses, heart failure was most common (40.1%).
Conclusions
This global meta-analysis revealed that the pooled rate of readmission following index TTS admissions was ∼17% and causes were mainly cardiac or respiratory.
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- R Desai
- Atlanta Veterans Affairs Medical Centre, Division of Cardiology, Atlanta, United States of America
| | - S Sachdeva
- Lady Hardinge Medical college and hospitals, Delhi, India
| | - S Singh
- Amsterdam University Medical Center, Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Amsterdam, Netherlands (The)
| | - S.K Rajan
- Medical City Plano, Department of Medicine, plano, Texas, United States of America
| | - A.S Shaik
- Silver Lane Medical Centre, Department of Medicine, East Hartford, Connecticut, United States of America
| | - M Haider
- New York-Presbyterian Hospital, Department of Internal Medicine, New York, United States of America
| | - H.K Fong
- UC Davis Medical Centre, Division of Cardiovascular Medicine, Sacramento, United States of America
| | - K Gangani
- Texas Health Arlington Memorial Hospital, Department of Internal Medicine, Arlington, Texas, United States of America
| | - R Sachdeva
- Morehouse School of Medicine, Atlanta VA Medical centre & Medical College of Georgia, Division of Cardiology, Augusta,Georgia, United States of America
| | - G Kumar
- Emory University & Atlanta VA Medical Centre, Division of Cardiology, Atlanta, Georgia, United States of America
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