Pancreatic Necrosectomy through Sinus Tract Endoscopy

Mahesh Kumar Goenka,Usha Goenka,Md.Yasin Mujoo,Indrajit Kumar Tiwary,Sanjay Mahawar,Vijay Kumar Rai 대한소화기내시경학회 2018 Clinical Endoscopy Vol.51 No.3

Background/Aims: Direct endoscopic pancreatic necrosectomy is increasingly being utilized to treat infected or symptomatic walledoffnecrosis (WON) located close to the stomach or duodenum. Laterally-placed WON has traditionally been treated surgically. Weevaluated a less utilized technique of sinus tract endoscopy (STE) for symptomatic laterally-placed WON. Methods: Two hundred seventy-six patients with acute pancreatitis admitted in our hospital, 32 had symptomatic or infected WONrequiring intervention. Of the 12 patients with laterally placed WON, 10 were treated by STE. STE was performed with a standard adultgastroscope passed through a percutaneous tract created by the placement of a 32-Fr drain. Results: Ten patients (7 males; mean age, 43.8 years) underwent STE. Mean number of sessions was 2.3 (range, 1–4), with mean timeof 70 minutes for each session (range, 15–70 minutes). While 9 patients had complete success, 1 patient had fever and chose to undergosurgery. Two patients developed pneumoperitoneum, which was treated conservatively. There was no mortality, cutaneous fistula, orrecurrence during follow-up. Conclusions: Laterally placed WON can be successfully managed by STE performed through a percutaneously placed drain. Details ofthe technique and end-points of STE require further evaluation.

Endoscopic Management of Gastrointestinal Leaks and Bleeding with the Over-the-Scope Clip: A Prospective Study

Mahesh Kumar Goenka,Vijay Kumar Rai,Usha Goenka,Indrajit Kumar Tiwary 대한소화기내시경학회 2017 Clinical Endoscopy Vol.50 No.1

Background/Aims: The over-the-scope clip (OTSC) is a device used for endoscopic closure of perforations, leaks and fistulas, and for endoscopic hemostasis. To evaluate the clinical effectiveness and safety of OTSC. Methods: Between October 2013 and November 2015, 12 patients underwent OTSC placement by an experienced endoscopist. OTSC was used for the closure of gastrointestinal (GI) leaks and fistula in six patients, three of which were iatrogenic (esophageal, gastric, and duodenal) and three of which were inflammatory. In six patients, OTSC was used for hemostasis of non-variceal upper GI bleeding. Endoscopic tattooing using India ink was used to assist the accurate placement of the clip. Results: All subjects except one with a colonic defect experienced immediate technical success as well as long-term clinical success, during a mean follow-up of 6 weeks. Only one clip was required to close each of the GI defects and to achieve hemostasis in all patients. There were no misfirings or complications of clips. The procedure was well tolerated, and patients were hospitalized for an average of 8 days (range, 3 to 10). Antiplatelet therapy was continued in patients with GI bleeding. Conclusions: In our experience, OTSC was safe and effective for the closure of GI defect and to achieve hemostasis of non-variceal GI bleeding.

Mucosal Changes in the Small Intestines in Portal Hypertension: First Study Using the Pillcam SB3 Capsule Endoscopy System

Mahesh Kumar Goenka,Bhavik Bharat Shah,Vijay Kumar Rai,Surabhi Jajodia,Usha Goenka 대한소화기내시경학회 2018 Clinical Endoscopy Vol.51 No.6

Background/Aims: To evaluate patients with portal hypertension (PH) of varied etiologies for portal hypertensive enteropathy (PHE)using the PillCam SB3 capsule endoscopy (CE) system. Methods: Consecutive patients with PH presenting with unexplained anemia and/or occult gastrointestinal bleeding were evaluatedusing the PillCam SB3 CE system. Abnormal findings were categorized as vascular or non-vascular. The patients with ongoing bleedingcaused by PHE were treated. The correlation of the CE scores of PHE with the clinical, laboratory, and endoscopic features wasdetermined. Results: Of the 43 patients included in the study, 41 (95.3%) showed PHE findings. These included varices (67.4%), red spots (60.5%),erythema (44.2%), villous edema (46.5%), telangiectasia (16.3%), and polyps (16.3%). The CE scores varied from 0 to 8 (mean±standarddeviation, 4.09±1.8). Five patients (11.6%) showed evidence of ongoing or recent bleeding due to PHE. Three of these five patientsunderwent endotherapy, and one patient underwent radiological coil placement. Conclusions: The PillCam SB3 CE system revealed a high prevalence of PHE in the patients with PH. Using this system, evidence ofbleeding due to PHE was found in a small but definite proportion of the patients.

Burdick’s Technique for Biliary Access Revisited

Mahesh Kumar Goenka,Vijay Kumar Rai 대한소화기내시경학회 2015 Clinical Endoscopy Vol.48 No.1

The precut sphincterotomy is used to facilitate selective biliary access in cases of difficult biliary cannulation. Needle-knife precut papillotomy is the standard of care but is associated with a high rate of complications such as pancreatitis, duodenal perforation, bleeding, etc. Sometimes during bowing of the sphincterotome/cannula and the use of guide wire to facilitate biliary cannulation, inadvertent formation of a false passage occurs in the 10 to 11 o’clock direction. Use of this step to access the bile duct by the intramucosal incision technique was first described by Burdick et al., and since then two more studies have also substantiated the safety and efficacy of this non-needle type of precut sphincterotomy. In this review, we discuss this non-needle technique of precut sphincterotomy and also share our experience using this ‘‘Burdick’s technique.’’

Endoscopic Management with a Novel Over-The-Scope Padlock Clip System

Mahesh Kumar Goenka,Gajanan Ashokrao Rodge,Indrajeet Kumar Tiwary 대한소화기내시경학회 2019 Clinical Endoscopy Vol.52 No.6

Background/Aims: The Padlock clip is a recently introduced over-the-scope clip (OTSC) that requires the use of an alternate techniqueand has a different design from previous OTSCs. However, data regarding its clinical use are limited. The aim of this study is to presentour clinical experience using this novel Padlock clip system. Methods: Between September 2018 and June 2019, 7 consecutive patients underwent Padlock clip application at our center by anexperienced endoscopist. A Padlock clip was used for achieving hemostasis in 4 patients presenting with gastrointestinal (GI) bleeding,as well as for endoscopic full-thickness resection in the remaining 3 patients. Results: All 7 patients achieved technical as well as clinical success, with absence of complications or rebleeding, during a follow-up ofa minimum of 3 weeks. All patients were hospitalized post procedure for a minimum of 48 hours, and an absence of adverse events wasnoted in our patient population throughout the procedure and post-procedure period. Antiplatelet therapy was reinstated shortly afterthe application of the Padlock clip, with no GI bleeding observed. Conclusions: The Padlock clip is a novel OTSC, with benefits that include safe, simple, and rapid deployment. Antiplatelet therapy maybe reinstated for patients, when necessary, shortly after applying the Padlock clip due to full-thickness closure of the tissue.

A prospective study of fully covered self-expandable metal stents for refractory benign pancreatic duct strictures

Bhavik Bharat Shah,Gajanan Ashokrao Rodge,Usha Goenka,Shivaraj Afzalpurkar,Mahesh Kumar Goenka 대한소화기내시경학회 2022 Clinical Endoscopy Vol.55 No.6

Background/Aims: Fully covered self-expanding metal stents (FCSEMSs) are a relatively novel option for treating painful main pan-creatic duct refractory strictures in patients with chronic pancreatitis. Herein, we aimed to assess the efficacy, feasibility, and safety ofFCSEMSs in this patient group. Methods: This prospective single-center study included patients who underwent endoscopic retrograde pancreatography withFCSEMS placement. The primary endpoints were the technical and clinical success rates. A reduction in visual analog scale pain scoreof >50% compared with that before stent placement was defined as clinical success. Secondary endpoints were resolution of pancreaticstrictures on fluoroscopy during endoscopic retrograde pancreatography and the development of stent-related adverse events. Results: Thirty-six patients were included in the analysis. The technical success rate was 100% (n=36) and the clinical success rate was86.1% (n=31). There was a significant increase in stricture diameter from 1.7 mm to 3.5 mm (p<0.001) after stent removal. The meanvisual analog scale pain score showed statistically significant improvement. At 19 months of follow-up, 55.6% of the patients were as-ymptomatic. Stent migration (16.7%), intolerable abdominal pain (8.3%), development of de novo strictures (8.3%), and mild pancre-atitis (2.8%) were the most common adverse events. Conclusions: FCSEMS placement showed good technical and clinical success rates for achieving pain relief in patients with refractorymain pancreatic duct strictures.