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Suprabhat Giri,Sridhar Sundaram,Harish Darak, Sanjay Kuma,Shobna Bhatia 대한소화기내시경학회 2020 Clinical Endoscopy Vol.53 No.6
Background/Aims: Bile leak is a common complication of cholecystectomy, and it is also observed in other conditions suchas ruptured liver abscess, hydatid cyst, and trauma. Endoscopic retrograde cholangiopancreatography (ERCP) is the first-linemanagement for such conditions. However, studies on the outcomes of endoscopic management for bile leaks with etiologies otherthan post-cholecystectomy injury are extremely limited. Methods: We conducted a retrospective review of patients with symptomatic bile leak who were referred to a tertiary care centerand who underwent ERCP between April 2016 and April 2019. The primary outcome was complete symptomatic resolution withoutextravasation of the contrast medium during the second ERCP conducted after 6 weeks. Results: In total, 71 patients presented with symptomatic bile leak. The etiologies of bile leak were post-cholecystectomy injury in34 (47.8%), liver abscess in 20 (28.1%), and post-hydatid cyst surgery in 11 (15.4%) patients. All patients were managed with ERCP,sphincterotomy, and stent placement for 6 weeks, except for one who underwent surgery. The primary outcome was achieved in 65(91.5%) of 71 patients. There was no significant difference in terms of outcome in relation to the interval between the diagnosis ofbile leak and ERCP. Conclusions: Most patients with bile leak can be successfully managed with ERCP even when performed on an elective basis.
Suprabhat Giri,Vaneet Jearth,Harish Darak,Sridhar Sundaram 대한소화기내시경학회 2022 Clinical Endoscopy Vol.55 No.6
Background/Aims: Cold snare polypectomy (CSP) is commonly used for the resection of colorectal polyps ≤10 mm. Data regardingthe influence of snare type on CSP effectiveness are conflicting. Hence, this meta-analysis aimed to compare the outcomes and safety ofthin- and thick-wire snares for CSP. Methods: A comprehensive search of the literature published between 2000 and 2021 was performed of various databases for compara-tive studies evaluating the outcomes of thin- versus thick-wire snares for CSP. Results: Five studies with data on 1,425 polyps were included in the analysis. The thick-wire snare was comparable to the thin-wiresnare with respect to complete histological resection (risk ratio [RR], 1.03; 95% confidence interval [CI], 0.97–1.09), overall bleeding(RR, 0.98; 95% CI, 0.40–2.40), polyp retrieval (RR, 1.01; 95% CI, 0.97–1.04), and involvement of submucosa in the resection specimen(RR, 1.28; 95% CI, 0.72–2.28). There was no publication bias and a small study effect, and the relative effects remained the same in thesensitivity analysis. Conclusions: CSP using a thin-wire snare has no additional benefit over thick-wire snares in small colorectal polyps. Factors otherthan snare design may play a role in improving CSP outcomes.