Endoscopic ultrasound-guided intervention for inaccessible papilla in advanced malignant hilar biliary obstruction

Partha Pal,Sundeep Lakhtakia 대한소화기내시경학회 2023 Clinical Endoscopy Vol.56 No.2

Advanced malignant hilar biliary obstruction (MHBO) with inaccessible papilla poses a significant challenge to endoscopists, as drainage of multiple liver segments may be warranted. Transpapillary drainage may not be feasible in patients with surgically altered anatomy, duodenal stenosis, prior duodenal self-expanding metal stent, and after initial transpapillary drainage, but require re-intervention for draining separated liver segments. Endoscopic ultrasound-guided biliary drainage (EUS-BD) and percutaneous trans-hepatic biliary drainage are the feasible options in this scenario. The major advantages of EUS-BD over percutaneous trans-hepatic biliary drainage include a reduction in patient discomfort and internal drainage away from the tumor, thus reducing the possibility of tissue or tumor ingrowth. With innovations, EUS-BD is helpful not only for bilateral communicating MHBO but also for non-communicating systems with bridging hilar stents or isolated right intra-hepatic duct drainage by hepatico-duodenostomy. EUS-guided multi-stent drainage with specially designed cannulas and guidewires has become a reality. A combined approach with endoscopic retrograde cholangiopancreatography for re-intervention, interventional radiology, and intraductal tumor ablative therapies has been reported. Stent migration and bile leakage can be minimized with proper stent selection and technique, and stent blocks can be managed with EUS-guided interventions in a majority of cases. Future comparative studies are required to establish the role of EUS-guided interventions in MHBO as rescue or primary therapy.

Management of achalasia in 2020: Per-oral endoscopic myotomy, Heller’s or dilatation?

Mohan Ramchandani,Partha Pal 소화기인터벤션의학회 2020 International journal of gastrointestinal interven Vol.9 No.2

Achalasia cardia is a rare esophageal motility disorder. Although a primary neurological disorder, the treatment modalities of achalasia are primarily endoscopic or surgical. Pneumatic dilatation (PD) or laparoscopic Heller’s myotomy (LHM) have been the mainstay of achalasia management for several decades. With the introduction of third space endoscopy, the endoscopic management of achalasia has revolutionized. Randomized studies have concluded the superiority of per-oral endoscopic myotomy (POEM) over PD. In addition, the short-term outcomes of POEM are similar to LHM. POEM is a relatively new technique and long-term data is eagerly awaited. The main concern after POEM is a high incidence of gastroesophageal reflux disease (GERD) which is found in about half of the patients undergoing this procedure. GERD is higher after POEM when compared to PD and LHM with fundoplication. The management of achalasia should be individualized and based on factors like patient characteristics (age, sex, comorbidities), subtyping on high resolution manometry, patient/doctor preference, and surgical risk of the patient.

Management of achalasia in 2020: Per-oral endoscopic myotomy, Heller’s or dilatation?

Mohan Ramchandani,Partha Pal 소화기인터벤션의학회 2020 Gastrointestinal Intervention Vol.9 No.2

Achalasia cardia is a rare esophageal motility disorder. Although a primary neurological disorder, the treatment modalities of achalasia are primarily endoscopic or surgical. Pneumatic dilatation (PD) or laparoscopic Heller’s myotomy (LHM) have been the mainstay of achalasia management for several decades. With the introduction of third space endoscopy, the endoscopic management of achalasia has revolutionized. Randomized studies have concluded the superiority of per-oral endoscopic myotomy (POEM) over PD. In addition, the short-term outcomes of POEM are similar to LHM. POEM is a relatively new technique and long-term data is eagerly awaited. The main concern after POEM is a high incidence of gastroesophageal reflux disease (GERD) which is found in about half of the patients undergoing this procedure. GERD is higher after POEM when compared to PD and LHM with fundoplication. The management of achalasia should be individualized and based on factors like patient characteristics (age, sex, comorbidities), subtyping on high resolution manometry, patient/doctor preference, and surgical risk of the patient.

Familial aggregation of inflammatory bowel disease in India: prevalence, risks and impact on disease behavior

Rupa Banerjee,Partha Pal,Susan Hutfless,B Girish Ganesh,D Nageshwar Reddy 대한장연구학회 2019 Intestinal Research Vol.17 No.4

Background/Aims: Information about familial aggregation of inflammatory bowel disease (IBD) in Asia is limited. We aimed to analyze the prevalence and risk of familial IBD in an Indian cohort and compare familial and sporadic cases. Methods: Familial IBD cases were identified from a large prospectively maintained IBD registry. The prevalence of IBD in first- and seconddegree relatives of index cases was evaluated. The disease behavior was compared to that of sporadic cases. Results: Total 3,553 patients (ulcerative colitis [UC], 2,053; Crohn’s disease [CD], 1,500) were included. Familial IBD was noted in 4.13% of CD and 4.34% of UC patients. Family history was commoner in pediatric group (<18 years) (P=0.0002; odds ratio [OR], 2.8; 95% confidence interval [CI], 1.6–4.8). Majority had paternal transmission (UC, 67.42%; CD, 70.97%). Concordance of disease type was higher in UC (79.7%) compared to CD (37.1%). Familial IBD was associated with higher cumulative relapse rate (CD, P<0.001; UC, P<0.001), higher cumulative rate of surgery (CD, P<0.001; UC, P<0.001) and higher rate of biologic use (CD, P=0.010; UC, P=0.015). Pan-colitis was higher in familial UC (P=0.003; OR, 1.935; 95% CI, 1.248–3.000). Fistulizing disease was commoner in familial CD (P=0.041; OR, 2.044; 95% CI, 1.030–4.056). Conclusions: The prevalence of familial IBD in India appears comparable to rest of Asia but lower than the West. It is associated with a younger age of onset, higher incidence of pan-colitis in UC and fistulizing complications in CD. Familial IBD has higher cumulative relapse, surgery and biologic use rates. Hence, family history of IBD could have important prognostic implications.

Very early onset inflammatory bowel disease in a South Asian country where inflammatory bowel disease is emerging: a distinct clinical phenotype from later onset disease

( Rupa Banerjee ),( Partha Pal ),( Zaheer Nabi ),( Upender Shava ),( Girish Ganesh ),( D. Nageshwar Reddy ) 대한장연구학회 2021 Intestinal Research Vol.19 No.4

Background/Aims: Information on pediatric inflammatory bowel disease (PIBD) and very early onset IBD (VEOIBD) are sparse in India, where IBD is emerging. We aimed to evaluate characteristics of VEOIBD and later onset PIBD (LO-PIBD) in India. Methods: We performed retrospective analysis of a large, prospectively maintained IBD registry. PIBD was divided in to VEOIBD (<6 years) and LO-PIBD (6-17 years). Demographic data, disease characteristics and treatment were compared between the PIBD groups and with other Asian/Western studies as well as the adult patients of the registry. Results: Of 3,752 IBD patients, 292 (7.8%) had PIBD (0-17 years) (175 Crohn’s disease [CD], 113 ulcerative colitis [UC], 4 IBD-undifferentiated; 22 VEOIBD [7.5%], and 270 LO-PIBD [92.5%]). VEOIBD patients had more severe disease compared to LO-PIBD in both UC (P= 0.003) and CD (P< 0.001). Familial IBD was more common in VEOIBD (13.6%) compared to LO-PIBD (9.2%). Ileal disease (L1) was an independent risk factor for diagnostic delay in pediatric CD. Diagnostic delay ( >6 months) was significantly lower in VEOIBD (40.9%) than in LO-PIBD (78.8%) (P< 0.001). Compared to other Asian and Western studies, extensive UC (72.5%) and complicated CD (stricturing/penetrating: 42.7%) were relatively more common. Perianal CD was relatively less frequent (7.4%). PIBD had a significantly higher number of complicated and ileal CD and extensive UC comparison to adult cohort of the registry. Conclusions: VEOIBD has more aggressive phenotype than LO-PIBD. Disease appears distinct from other Asian and Western studies and adult onset disease, with more complicated CD and extensive UC. (Intest Res 2021;19:398-407)

Proposal of novel staging system CNM (Crohn’s primary site, nodes, mesentery) to predict postoperative recurrence of Crohn’s disease

Guduru Venkat Rao,Partha Pal,Anuradha Sekaran,Pradeep Rebala,Manu Tandan,D. Nageshwar Reddy 대한장연구학회 2023 Intestinal Research Vol.21 No.2

After oncologic resection, histological grading and staging of the tumor give important prognostic information about the future risk of recurrence and hence influence the subsequent management plan. Several studies and their meta-analysis have shown that various histological features (e.g., microscopic positive resection margins, plexitis, granuloma, mesenteric inflammatory activity) can predict postoperative clinical/endoscopic/surgical recurrence after resection in Crohn’s disease (CD). Inclusion of mesentery in surgical resection specimens has been shown to reduce surgical recurrence after ileocolonic resection in CD. However, there is no uniform histopathological staging system for risk stratification in postoperative CD to systematically predict postoperative recurrence. This is because the prediction to date is based on clinical characteristics (smoking status, disease phenotype, surgical history). Histopathological predictors are still not adopted in routine clinical practice due to the lack of a uniform staging system, heterogeneity of published studies and lack of standardized definition of histological features. In this article, we attempted to incorporate all such histological features in a single histological staging system CNM (Crohn’s primary site [resection margin positivity, plexitis, granuloma, depth of infiltration], nodes [presence of granuloma], mesentery [involved or not]) in surgical resection specimen in CD. The proposed CNM classification would help to enable systematic reporting, design future clinical trials, stratify postoperative recurrence risk and choose appropriate postoperative prophylaxis.

Ascertaining polarity of public opinions on Bangladesh cricket using machine learning techniques

Faruque M. Abdullah,Rahman Saifur,Chakraborty Partha,Choudhury Tanupriya,Um Jung-Sup,Singh Thipendra Pal 대한공간정보학회 2022 Spatial Information Research Vol.30 No.2

In the present world, we are not only the consumers of information but creators as well. The virtual world of social media, which is considered a free open forum for discussion; provides its participants a chance to shape or re-shape the digital information by expressing opinions. These opinions generally contain different types of sentiments. Sentiment analysis is a tool that performs the computational study of identifying and extracting sentiment content of textual data that can be used to classify those public opinions posted on various topics in social media. In this paper, a sentiment polarity detection approach is presented, that detects the polarity of textual Facebook posts in Bangla containing people’s point of views on Bangladesh Cricket using three popular supervised machine learning algorithms named Naive Bayes (NB), support vector machines (SVM), and logistic regression (LR). Comparative result analysis is also provided between classifiers, where LR performed slightly better than SVM and NB by considering n-gram as a feature with an accuracy of 83% in the present world, we are not only the consumers of information but creators as well. The virtual world of social media, which is considered a free open forum for discussion; provides its participants a chance to shape or re-shape the digital information by expressing opinions. These opinions generally contain different types of sentiments. Sentiment analysis is a tool that performs the computational study of identifying and extracting sentiment content of textual data that can be used to classify those public opinions posted on various topics in social media. In this paper, a sentiment polarity detection approach is presented, that detects the polarity of textual Facebook posts in Bangla containing people’s point of views on Bangladesh Cricket using three popular supervised machine learning algorithms named Naive Bayes (NB), support vector machines (SVM), and logistic regression (LR). Comparative result analysis is also provided between classifiers, where LR performed slightly better than SVM and NB by considering n-gram as a feature with an accuracy of 83%.

Ascertaining polarity of public opinions on Bangladesh cricket using machine learning techniques

Faruque M. Abdullah,Rahman Saifur,Chakraborty Partha,Choudhury Tanupriya,Um Jung-Sup,Singh Thipendra Pal 대한공간정보학회 2022 Spatial Information Research Vol.30 No.1

In the present world, we are not only the consumers of information but creators as well. The virtual world of social media, which is considered a free open forum for discussion; provides its participants a chance to shape or re-shape the digital information by expressing opinions. These opinions generally contain different types of sentiments. Sentiment analysis is a tool that performs the computational study of identifying and extracting sentiment content of textual data that can be used to classify those public opinions posted on various topics in social media. In this paper, a sentiment polarity detection approach is presented, that detects the polarity of textual Facebook posts in Bangla containing people’s point of views on Bangladesh Cricket using three popular supervised machine learning algorithms named Naive Bayes (NB), support vector machines (SVM), and logistic regression (LR). Comparative result analysis is also provided between classifiers, where LR performed slightly better than SVM and NB by considering n-gram as a feature with an accuracy of 83%.