Predicting Colonoscopy Time: A Quality Improvement Initiative

Deepanshu Jain,Abhinav Goyal,Stacey Zavala 대한소화기내시경학회 2016 Clinical Endoscopy Vol.49 No.6

Background/Aims: There is lack of consensus on the optimal time allotted for colonoscopy, which increases patient wait times. Ouraim was to identify and quantify the individual pre-procedural factors that determine the total procedure time (TPT) of colonoscopy. Methods: This retrospective study involved 4,494 subjects, undergoing outpatient colonoscopy. Effects of age, sex, body mass index,abdominal surgery history, procedure indication (screening, surveillance, or diagnostic), procedure session (morning or afternoon),and endoscopist’s experience (fellow or attending) on TPT were evaluated using multiple regression analysis. A p<0.05 was consideredsignificant. Results: A total of 1,239 subjects satisfied the inclusion/exclusion criteria. Women, older individuals, and those with a history ofabdominal surgery were found to have a shorter TPT (p>0.05) as did afternoon session colonoscopies (p=0.004). Less experiencedendoscopists had longer TPTs (p>0.05). Screening (p=0.01) and surveillance (p=0.008) colonoscopies had a longer TPT than diagnosticprocedures. Overall, the F-value of the regression model was 0.0009. Conclusions: The indication for colonoscopy and the time of day have statistically significant associations with TPT. These results willhelp in streamlining workflow, reduce wait time, and improve patient satisfaction.

Endoscopic Sleeve Gastroplasty - A New Tool to Manage Obesity

Deepanshu Jain,Bharat Singh Bhandari,Ankit Arora,Shashideep Singhal 대한소화기내시경학회 2017 Clinical Endoscopy Vol.50 No.6

Obesity is a growing pandemic across the world. Dietary restrictions and behavior modifications alone have a limited benefit. Bariatric surgery, despite being the current gold standard, has limited acceptance by patients due to cost and associated morbidity. In our review, we have discussed nine original studies describing endoscopic sleeve gastroplasty (ESG). A total of 172 subjects successfully underwent ESG. Of 65 subjects with follow up data, 95.4% (62/65) had intact gastric sleeve confirmed via esophagogastroduodenoscopy or oral contrast study at the end of study specific follow up interval (the longest being 6 months). Individual studies reported a technical success rate for intact gastric sleeve from as low as 50% to as high as 100%. A statistically significant (p<0.05) weight loss was reported in seven of the eight studies with available data. None of the patients experienced any intra-procedure complications, and approximately 2.3% (4/172) of patients experienced major post-procedure complications; however, no mortality was reported. Majority of the studies reported relatively high incidence of minor post-procedure complications, which improved with symptomatic treatment alone. Good patient tolerance with comparable clinical efficacy in achieving and sustaining desired weight loss makes ESG an attractive option to consider among other bariatric therapies.

Endoscopic ultrasound guided gallbladder drainage by using Lumen apposing metal stent for acute cholecystitis: systematic review

Deepanshu Jain,Bharat Singh Bhandari,Nikhil Agrawal,Shashideep Singhal 대한소화기내시경학회 2018 Clinical Endoscopy Vol.51 No.5

Surgery remains the standard treatment for acute cholecystitis except in high-risk candidates where percutaneous transhepatic gallbladderdrainage (PT-GBD), endoscopic transpapillary cystic duct stenting (ET-CDS), and endoscopic ultrasound-guided gallbladder drainage(EUS-GBD) are potential choices. PT-GBD is contraindicated in patients with coagulopathy or ascites and is not preferred by patientsowing to aesthetic reasons. ET-CDS is successful only if the cystic duct can be visualized and cannulated. For 189 patients whounderwent EUS-GBD via insertion of a lumen-apposing metal stent (LAMS), the composite technical success rate was 95.2%, which increasedto 96.8% when LAMS was combined with co-axial self-expandable metal stent (SEMS). The composite clinical success rate was96.7%. We observed a small risk of recurrent cholecystitis (5.1%), gastrointestinal bleeding (2.6%) and stent migration (1.1%). Cauteryenhanced LAMS significantly decreases the stent deployment time compared to non-cautery enhanced LAMS. Prophylactic placementof a pigtail stent or SEMS through the LAMS avoids re-interventions, particularly in patients, where it is intended to remain in situ indefinitely. Limited evidence suggests that the effcacy of EUS-GBD via LAMS is comparable to that of PT-GBD with the former showingbetter results in postoperative pain, length of hospitalization, and need for antibiotics. EUS-GBD via LAMS is a safe and effcaciousoption when performed by experts.

De-novo Gastrointestinal Anastomosis With Lumen Apposing Metal Stent

Deepanshu Jain,Ankit Chhoda,Abhinav Sharma,Shashideep Singhal 대한소화기내시경학회 2018 Clinical Endoscopy Vol.51 No.5

Gastric outlet obstruction, afferent or efferent limb obstruction, and biliary obstruction among patients with altered anatomy oftenrequire surgical intervention which is associated with significant morbidity and mortality. Endoscopic dilation for benign etiologiesrequires multiple sessions, whereas self-expandable metal stents used for malignant etiologies often fail due to tumor in-growth. Lumenapposing metal stents, placed endoscopically with the intent of creating a de-novo gastrointestinal anastomosis bypassing the site ofobstruction, can potentially achieve similar effcacy, with a much lower complication rate. In our study cohort (n=79), the compositetechnical success rate and clinical success rate was 91.1% (72/79) and 97.2% (70/72), respectively. Five different techniques were used:43% (34/79) underwent the balloon-assisted method, 27.9% (22/79) underwent endoscopic ultrasound-guided balloon occludedgastro-jejunostomy bypass, 20.3% (16/79) underwent the direct technique, 6.3% (5/79) underwent the hybrid rendezvous technique,and 2.5% (2/79) underwent natural orifice transluminal endoscopic surgery (NOTES)-assisted procedure. All techniques required anechoendoscope except NOTES. In all, 53.2% (42/79) had non-cautery enhanced Axios stent, 44.3% (35/79) had hot Axios stent, and2.5% (2/79) had Niti-S spaxus stent. Symptom-recurrence was seen in 2.8%, and 6.3% had a complication (bleeding, abdominal pain orperitonitis). All procedures were performed by experts at centers of excellence with adequate surgical back up.

Atraumatic Splenic Hemorrhage as a Rare Complication of Pancreatitis: Case Report and Literature Review

Deepanshu Jain,Byeori Lee,Michael Rajala 대한소화기내시경학회 2020 Clinical Endoscopy Vol.53 No.3

Splenic hemorrhage (hematoma and rupture) is a rare complication of pancreatitis. In this article, we present a rare case of spontaneoussplenic rupture as a complication of acute pancreatitis. A literature review was also completed to describe the patient characteristics,associated pancreatitis etiology, clinical presentations, risk factors, diagnostic and treatment modalities, and outcomes.

Stepwise Algorithmic Approach to Endoscopic Removal of Biliary Partially Covered and Uncovered Self-Expanding Metal Stents

Deepanshu Jain,Assaf Stein,Muhammad K. Hasan 대한소화기내시경학회 2021 Clinical Endoscopy Vol.54 No.4

Self-expanding metal stents play a crucial role in the management of patients with biliary obstruction. Endoscopic extraction ofuncovered metal stents (UCMSs) and partially covered metal stents (PCMSs) could be challenging because of tissue ingrowth. Nostandardized technique can guarantee universal success. We present our technique and experience of endoscopic extraction of biliarystents in two patients with a UCMS and three patients with a PCMS. Three of the five patients had a previous failed attempt of stentextraction at an outside hospital. Overall, our composite success rate was 80% (4/5). The individual success rate was 100% (3/3) forPCMSs and 50% (1/2) for UCMSs. The stent-in-stent technique, in which a fully covered metal stent is placed through an existingUCMS/PCMS, was used in 60% (3/5) of the cases, with a success rate of 66.7% (2/3). We share our algorithmic approach to eachcase, with detailed emphasis on the technical aspects of the procedure.

Highly efficient magnetically tunable high frequency spur-line notch filter

Deepanshu Sharma,Neeraj Khare 한국물리학회 2020 Current Applied Physics Vol.20 No.6

We report a cobalt ferrite nanorods (CFO NRs) based magnetically tunable spur-line notch filter where vertically aligned CFO NRs has been grown on silver nanoparticles coated silicon substrate. The CFO NRs are coupled with high frequency spur-line bandstop filter in flip-chip configuration and the device showed excellent tunable microwave properties in the presence of a low bias magnetic field. The center frequency of the tunable filter is ~16.4 GHz which is shifted to ~14.9 GHz with ~8.7% tunability by applying bias magnetic field ~320 Oe. The magnetic field tuning of the center frequency is explained on the basis of the change in permeability value of the CFO NRs with bias magnetic field as the NRs are used in the partially magnetized state. For validation, permeability value is also calculated by using numerical equations. The experimental reflection of the device has been supported with a simulation using CST microwave studio software.

Transoral Incisionless Fundoplication for Refractory Gastroesophageal Reflux Disease: Where Do We Stand?

Deepanshu Jain,Shashideep Singhal 대한소화기내시경학회 2016 Clinical Endoscopy Vol.49 No.2

Gastroesophageal reflux disease (GERD) is a chronic, progressive, and costly medical condition affecting a substantial proportion of the world population, predominantly the Western population. The available treatment options for patients with refractory GERD symptoms are limited to either laparoscopic surgery with significant sequelae or potentially lifelong, high-dose proton pump inhibitor therapy. The restoration of the antireflux competence of the gastroesophageal junction at the anatomic and physiologic levels is critical for the effective long-term treatment of GERD. Transoral incisionless fundoplication (TIF) surgery is a safe, well-tolerated, and effective treatment that has yielded significant symptomatic improvement in patients with medically refractory GERD symptoms. In this review article, we have summarized case series and reports describing the role of TIF for patients with gastroesophageal reflux symptoms. The reported indications, techniques, complications, and success rates are also discussed.

Obesity and Cecal Intubation Time

Deepanshu Jain,Abhinav Goyal,Jorge Uribe 대한소화기내시경학회 2016 Clinical Endoscopy Vol.49 No.2

Background/Aims: Obesity is a much-debated factor with conflicting evidence regarding its association with cecum intubation rates during colonoscopy. We aimed to identify the association between cecal intubation (CI) time and obesity by eliminating confounding factors. Methods: A retrospective chart review of subjects undergoing outpatient colonoscopy was conducted. The population was categorized by sex and obesity (body mass index [BMI, kg/m2]: I, <24.9; II, 25 to 29.9; III, ≥30). CI time was used as a marker for a difficult colonoscopy. Mean CI times (MCT) were compared for statistical significance using analysis of variance tests. Results: A total of 926 subjects were included. Overall MCT was 15.7±7.9 minutes, and it was 15.9±7.9 and 15.5±7.9 minutes for men and women, respectively. MCT among women for BMI category I, II, and III was 14.4±6.5, 15.5±8.3, and 16.2±8.1 minutes (p=0.55), whereas for men, it was 16.3±8.9, 15.9±8.0, and 15.6±7.2 minutes (p=0.95), respectively. Conclusions: BMI had a positive association with CI time for women, but had a negative association with CI for men.

Esophageal Stricture Prevention after Endoscopic Submucosal Dissection

Deepanshu Jain,Shashideep Singhal 대한소화기내시경학회 2016 Clinical Endoscopy Vol.49 No.3

Advances in diagnostic modalities and improvement in surveillance programs for Barrett esophagus has resulted in an increase in the incidence of superficial esophageal cancers (SECs). SEC, due to their limited metastatic potential, are amenable to non-invasive treatment modalities. Endoscopic ultrasound, endoscopic mucosal resection, and endoscopic submucosal dissection (ESD) are some of the new modalities that gastroenterologists have used over the last decade to diagnose and treat SEC. However, esophageal stricture (ES) is a very common complication and a major cause of morbidity post-ESD. In the past few years, there has been a tremendous effort to reduce the incidence of ES among patients undergoing ESD. Steroids have shown the most consistent results over time with minimal complications although the preferred mode of delivery is debatable, with both systemic and local therapy having pros and cons for specific subgroups of patients. Newer modalities such as esophageal stents, autologous cell sheet transplantation, polyglycolic acid, and tranilast have shown promising results but the depth of experience with these methods is still limited. We have summarized case reports, prospective single center studies, and randomized controlled trials describing the various methods intended to reduce the incidence of ES after ESD. Indications, techniques, outcomes, limitations, and reported complications are discussed.