Mucosal incision-assisted biopsy versus endoscopic ultrasound-assisted tissue acquisition for subepithelial lesions: a systematic review and meta-analysis

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.

Outcomes of thin versus thick-wire snares for cold snare polypectomy: a systematic review and meta-analysis

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.

Efficacy and Safety of Endoscopic Stenting for Crohn's Disease Related Strictures: A Systematic Review and Meta-analysis

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.

Prevalence of hepatitis B virus and hepatitis C virus infection in patients with inflammatory bowel disease: a systematic review and meta-analysis

( Suprabhat Giri ),( Dhiraj Agrawal ),( Shivaraj Afzalpurkar ),( Sunil Kasturi ),( Amrit Gopan ),( Sridhar Sundaram ),( Aditya Kale ) 대한장연구학회 2023 Intestinal Research Vol.21 No.3

Background/Aims: The data on the prevalence of hepatitis B virus (HBV) and hepatitis C virus (HCV) infection in patients with inflammatory bowel disease (IBD) are conflicting. The present systematic review was thus conducted to study the prevalence of HBV and HCV markers in patients with IBD. Methods: A comprehensive literature search of 3 databases was conducted from 2000 to April 2022 for studies evaluating the prevalence of HBV or HCV in patients with IBD. Pooled prevalence rates across studies were expressed with summative statistics. Results: A total of 34 studies were included in the final analysis. The pooled prevalence of hepatitis B surface antigen (HBsAg) and hepatitis B core antibodies were 3.3% and 14.2%, respectively. In HBsAg positive IBD patients, hepatitis B e antigen positivity and detectable HBV DNA were seen in 15.3% and 61.0% of patients, respectively. Only 35.6% of the IBD patients had effective HBV vaccination. The pooled prevalence of anti-HCV and detectable HCV RNA were 1.8% and 0.8%, respectively. The pooled prevalence of markers of HBV infection was higher in Asian studies, while the prevalence of markers of HCV infection was higher in European studies. The prevalence of viral hepatitis markers was similar between IBD patients and the general population and that between ulcerative colitis and Crohn’s disease. Conclusions: The prevalence of markers of viral hepatitis remains same as the general population with significant regional variations, although the quality of evidence remains low due to publication bias. Only a small proportion of IBD patients had an effective HBV vaccination, requiring improvement in screening and vaccination practices. (Intest Res 2023;21:392-405)

Outcomes of Endoscopic Management among Patients with Bile Leak of Various Etiologies at a Tertiary Care Center

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.

Influence of biliary stents on the diagnostic outcome of endoscopic ultrasound–guided tissue acquisition from solid pancreatic lesions: a systematic review and meta-analysis

Suprabhat Giri,Shivaraj Afzalpurkar,Sumaswi Angadi,Jijo Varghese,Sridhar Sundaram 대한소화기내시경학회 2023 Clinical Endoscopy Vol.56 No.2

Background/Aims: This meta-analysis analyzed the effect of an indwelling biliary stent on endoscopic ultrasound (EUS)-guided tissue acquisition from pancreatic lesions. Methods: A literature search was performed to identify studies published between 2000 and July 2022 comparing the diagnostic outcomes of EUS-tissue acquisition (TA) in patients with or without biliary stents. For non-strict criteria, samples reported as malignant or suspicious for malignancy were included, whereas for strict criteria, only samples reported as malignant were included in the analysis. Results: Nine studies were included in this analysis. The odds of an accurate diagnosis were significantly lower in patients with indwelling stents using both non-strict (odds ratio [OR], 0.68; 95% confidence interval [CI], 0.52–0.90) and strict criteria (OR, 0.58; 95% CI, 0.46–0.74). The pooled sensitivity with and without stents were similar (87% vs. 91%) using non-strict criteria. However, patients with stents had a lower pooled sensitivity (79% vs. 88%) when using strict criteria. The sample inadequacy rate was comparable between groups (OR, 1.12; 95% CI, 0.76–1.65). The diagnostic accuracy and sample inadequacy were comparable between plastic and metal biliary stents. Conclusions: The presence of a biliary stent may negatively affect the diagnostic outcome of EUS-TA for pancreatic lesions.

Outcomes and predictors of response to endotherapy in pancreatic ductal disruptions with refractory internal and high-output external fistulae

Sridhar Sundaram,Biswa Ranjan Patra,Dhaval Choksi,Suprabhat Giri,Aditya Kale,Nitin Ramani,Abhijeet Karad,Akash Shukla 한국간담췌외과학회 2022 Annals of hepato-biliary-pancreatic surgery Vol.26 No.4

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.