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RISS 인기검색어
- 검색키워드
- 저자 : Sridhar Sundaram (검색결과 12 건)
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Sridhar Sundaram,Sidharth Harindranath,Praveen Kumar Rao,Nitin Ramani,Aditya Kale,Shraddha Patkar 소화기인터벤션의학회 2021 Gastrointestinal Intervention Vol.10 No.4
Combined biliary and duodenal stent placement has been reported previously in multiple series. Rarely, colonic obstruction may present simultaneously with duodenal and biliary obstruction in advanced pancreaticobiliary cancers. Biliary, duodenal and colonic obstruction managed simultaneously using endoscopic modalities have been reported in only one case report previously. Here we report outcomes of a case of carcinoma of the gall bladder with biliary, gastric outlet and colonic obstruction managed by endoscopic placement of biliary, gastroduodenal and colonic self-expanding metal stents.
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Sridhar Sundaram,Sidharth Harindranath,Praveen Kumar Rao,Nitin Ramani,Aditya Kale,Shraddha Patkar 소화기인터벤션의학회 2021 International journal of gastrointestinal interven Vol.10 No.4
Combined biliary and duodenal stent placement has been reported previously in multiple series. Rarely, colonic obstruction may present simultaneously with duodenal and biliary obstruction in advanced pancreaticobiliary cancers. Biliary, duodenal and colonic obstruction managed simultaneously using endoscopic modalities have been reported in only one case report previously. Here we report outcomes of a case of carcinoma of the gall bladder with biliary, gastric outlet and colonic obstruction managed by endoscopic placement of biliary, gastroduodenal and colonic self-expanding metal stents.
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Outcomes of Dilation of Recalcitrant Pancreatic Strictures Using a Wire-Guided Cystotome
Sridhar Sundaram,Dhaval Choksi,Aditya Kale,Suprabhat Giri,Biswaranjan Patra,Shobna Bhatia,Akash Shukla 대한소화기내시경학회 2021 Clinical Endoscopy Vol.54 No.6
Background/Aims: Pancreatic strictures in chronic pancreatitis are treated using endoscopic retrograde cholangiopancreatography(ERCP) with plastic stent placement. The management of recalcitrant strictures remains a challenge, with the use of a Soehendrastent retriever or a needle knife described in case reports. Here, we discuss our experience with dilation of dominant pancreaticstrictures with a 6-Fr cystotome. Methods: A retrospective review of an endoscopy database was performed to search for patients with pancreatic strictures recalcitrant toconventional methods of dilation in which a cystotome was used. Technical success was defined as the successful dilation of the stricturewith plastic stent placement. Functional success was defined as substantial pain relief or resolution of pancreatic fistulae. Results: Ten patients (mean age, 30.8 years) underwent dilation of a dominant pancreatic stricture secondary to chronic pancreatitis,with a 6-Fr cystotome. Seven patients presented with pain. Three patients had pancreatic fistulae (two had pancreatic ascites and onehad a pancreaticopleural fistula). The median stricture length was 10 mm (range, 5–25 mm). The head of the pancreas was the mostcommon location of the stricture (60%). Technical and functional success was achieved in all patients. One patient had self-limitingbleeding, whereas another patient developed mild post-ERCP pancreatitis. Conclusions: The use of a 6-Fr cystotome (diathermy catheter) can be an alternative method for dilation of recalcitrant pancreaticstrictures after the failure of conventional modalities.
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An unusual stent migration after endoscopic ultrasound-guided choledochoduodenostomy
Aditya Kale,Sridhar Sundaram,Manish Dodmani 소화기인터벤션의학회 2022 International journal of gastrointestinal interven Vol.11 No.1
Summary of event: Endoscopic ultrasound-guided choledochoduodenostomy (EUS-CD) with the placement of a fully covered self-expandable metal stent (SEMS) is an alternative method to percutaneous transhepatic biliary drainage in cases of failed endoscopic retrograde cholangiopancreatography (ERCP) for malignant distal biliary obstruction. We report the case of a 64-year-old female who underwent EUS-CD with placement of a fully covered SEMS for obstructive jaundice due to distal bile duct obstruction by a pancreatic head mass and failed ERCP. Five months after the procedure, she presented with spontaneous expulsion of the stent in vomitus. She did not have bile leak and jaundice due to the formation of an epithelialized fistulous tract between the bile duct and duodenum (choledocho-duodenal fistula). Teaching point: Delayed distal migration of a fully covered SEMS after EUS-CD can occur. The formation of an epithelialized choledochoduodenal fistula prevented the occurrence of bile leak, pneumoperitoneum and perforation. Re-stenting through the same tract is possible. Stents with antimigration flanges or lumen-apposing metal stents may prevent migration.
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An unusual stent migration after endoscopic ultrasound-guided choledochoduodenostomy
Aditya Kale,Sridhar Sundaram,Manish Dodmani 소화기인터벤션의학회 2022 Gastrointestinal Intervention Vol.11 No.1
Summary of event: Endoscopic ultrasound-guided choledochoduodenostomy (EUS-CD) with the placement of a fully covered self-expandable metal stent (SEMS) is an alternative method to percutaneous transhepatic biliary drainage in cases of failed endoscopic retrograde cholangiopancreatography (ERCP) for malignant distal biliary obstruction. We report the case of a 64-year-old female who underwent EUS-CD with placement of a fully covered SEMS for obstructive jaundice due to distal bile duct obstruction by a pancreatic head mass and failed ERCP. Five months after the procedure, she presented with spontaneous expulsion of the stent in vomitus. She did not have bile leak and jaundice due to the formation of an epithelialized fistulous tract between the bile duct and duodenum (choledocho-duodenal fistula). Teaching point: Delayed distal migration of a fully covered SEMS after EUS-CD can occur. The formation of an epithelialized choledochoduodenal fistula prevented the occurrence of bile leak, pneumoperitoneum and perforation. Re-stenting through the same tract is possible. Stents with antimigration flanges or lumen-apposing metal stents may prevent migration.
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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.
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Suprabhat Giri,Amrit Gopan,Sridhar Sundaram,Aditya Kale 대한소화기학회 2022 대한소화기학회지 Vol.80 No.4
Background/Aims: Endoscopic stenting is an evolving treatment for symptomatic Crohn's strictures. Several case series and small studies have reported its efficacy. Future studies can be designed based on a systematic review of the evaluation of efficacy. Hence, this meta-analysis was conducted to assess the critical role of stents in the management of intestinal strictures associated with Crohn's disease (CD). Methods: A literature search of various databases from 2000 to February 2022 was conducted for studies evaluating the outcome of stents in patients with CD-related stricture. The outcomes assessed included technical and clinical success, adverse events, symptom recurrence, and the need for a surgical resection. Pooled event rates across studies were expressed with summative statistics. Results: Ten studies with 170 patients were included in the present analysis. The pooled event rates for technical success, clinical success, stent migration, and post-procedural pain were 98.2% (95% CI, 95.8-100), 71.3% (95% CI, 57.4-85.1), 32% (95% CI, 0.0-65.3) and 20.2% (95% CI, 4.1-36.2), respectively. The cumulative recurrence rate and need for surgery were 40.1% (95% CI, 20.3-59.9) and 8.6% (95% CI, 1.7-15.5), respectively. Subgroup analysis showed that partially-covered (PC) self-expanding metallic stent (SEMS) was significantly better than fully-covered SEMS with a lower stent migration rate and symptom recurrence rate. Conclusions: Overall efficacy of stents in the management of CD-related stricture remains moderate with a low complication rate. Among the stents, PC-SEMS may be associated with a more favorable outcome. Future studies will be needed to determine the long-term benefits of endoscopic stenting.
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Suprabhat Giri,Shivaraj Afzalpurkar,Sumaswi Angadi,Sridhar Sundaram 대한소화기내시경학회 2022 Clinical Endoscopy Vol.55 No.5
Background/Aims: Mucosal incision-assisted biopsy (MIAB) for tissue acquisition (TA) from subepithelial lesions (SELs) is emerging as an alternative to endoscopic ultrasound (EUS)-guided TA. Only a limited number of studies compared the diagnostic utility of MIAB and EUS for upper gastrointestinal (GI) SELs; therefore, we conducted this systematic review and meta-analysis. Methods: A comprehensive literature search from January 2020 to January 2022 was performed to compare the diagnostic accuracy and safety of MIAB and EUS-guided TA for upper GI SELs. Results: Seven studies were included in this meta-analysis. The pooled technical success rate (risk ratio [RR], 0.96; 95% confidence in- terval [CI], 0.89–1.04) and procedural time (mean difference=–4.53 seconds; 95% CI, –22.38 to 13.31] were comparable between both the groups. The overall chance of obtaining a positive diagnostic yield was lower with EUS than with MIAB for all lesions (RR, 0.83; 95% CI, 0.71–0.98) but comparable when using a fine-needle biopsy needle (RR, 0.93; 95% CI, 0.83–1.04). The positive diagnostic yield of MIAB was higher for lesions <20 mm (RR, 0.75; 95% CI, 0.63–0.89). Six studies reported no adverse events. Conclusions: MIAB can be considered an effective alternative to EUS-guided TA for upper GI SELs without an increased risk of ad- verse events.
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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.
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