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RISS 인기검색어
- 검색키워드
- 저자 : ( Amit Rastogi ) (검색결과 2 건)
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Amit Rastogi 대한소화기내시경학회 2013 Clinical Endoscopy Vol.46 No.2
Optical diagnosis of polyp histology can potentially result in enormous cost savings by way of the “resect and discard” strategy for diminutive polyps and the “do not resect” strategy for diminutive hyperplastic polyps in the distal colon. Narrow Band Imaging (NBI) highlights the surface mucosal and vascular pattern on polyps and has been shown to accurately characterize adenomatous and hyperplastic polyps by experts. However, the results have been a little discouraging amongst lesser experienced endoscopists. Studies have also shown that using the NBI diagnosis of diminutive polyp histology, experts can accurately define the future surveillance colonoscopy intervals. However nonexperts in academic or community setting have as yet failed to achieve the recommended thresholds. The subjectivity in assessment by endoscopists leads to the variable accuracy rates and can be circumvented by computer based automated tools. Although initial experience with a few computer based algorithms have shown accuracies comparable to experts, further refinement and validation will be required before these can be implemented in clinical practice. Incorporation of optical diagnosis of diminutive polyps into clinical practice is bound to face several hurdles. But the potential for enormous cost saving makes it an attractive strategy that can make colonoscopy more cost effective.
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( Rohan Jagat Chaudhary ),( V. Sagar Puppala ),( Thiagarajan S. ),( Prashant Bhangui ),( Amit Rastogi ),( Tarun Piplani ),( S. Baijal ),( V. Vohra ),( Arvinder Singh Soin ) 대한간학회 2020 춘·추계 학술대회 (KASL) Vol.2020 No.1
Aims: To study the outcomes of our algorithmic-approach for safe optimisation and surgical planning in patients with Hilar- Block. Methods: Retrospective-analysis of prospectively-maintained database of patients undergoing surgery for hilar-block from Jan2013-May2019 was done.Our approach includes Imaging, Biliary-decompression, Future-liver-remnant-Volume(FLR)augmentation based on CT-Volumetry and FLR-function assessment. Results: 45cases of hilar-blocks underwent resections.32were Hilar-cholangiocarcinoma,5-Intrahepatic-cholangiocarcinoma, 6-Ca-Gall-Bladder with hilar-block,2-IgG4-sclerosing- cholangitis-presenting as malignant-masquerade. The mean age was57±12years and 30(67%) were males. On MRCP, hilar-blocks types 2,3a,3b,4 were 3,15,17,10 respectively. Pre-operative biliary-decompression of FLR were done in 21cases[19 PTBD(Percutaneous-Transhepatic-biliary-drainage)/ 2 EBD(Endoscopic-biliary-drainage)]. Additional PTBD were done in 2 cases for inadequate fall in SB, and 3 for cholangitis. The mean SB(Serum-Total-Bilirubin) at presentation was 9.57±5.58mg/dl. The rate of fall of S.bilirubin was faster in patients < 50yrs of age and type-3 hilar-blocks than in type-4 hilar- blocks. PVE was performed in 14cases and FLR hypertrophy of 11.3± 3.03%was achieved.The quality of FLR was assessed with LAI(n=39),fibroscan(n=17), ICGR15(n=12), HVPG (n=35), and selective-remnant-biopsy(n=14,if HVPG >10 mm Hg,ICGR15> 15%, or in-suspected steatosis or fibrosis).After optimization, surgical procedures done were Right-Hepatectomy(7), Right-TriSectorectomy(7), Extended-Right-Hepatectomy(9), Left-Hepatectomy(6),Extended-Left-Hepatectomy(5), Left-Trisectorectomy( 8) and Bile-duct-excision-alone(3).Eleven patients required concomitant vascular-resections and reconstructions(- 8portal-vein-resections, 2 hepatic-arterial-resection,1both) to obtain R0. R0 and R1 resections were achieved in 42(93%) and 3 patients. Clavien-Dindo-Grade3/4 complications were 22.2%(n=10). 8(18%)patients had Post-Hepatectomy-Liver- Failure.Overall operative-mortality was 5/45(11.1%). Conclusions: Our algorithmic approach for safe optimization by preoperative-biliary-drainage, FLR-augmentation and FLR-functional- assessment have led to a high rate of R0 major liver resection and good outcomes in patients with hilar-blocks.Augmentation of FLR can also increase resectability in borderline resectable cases.
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