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        Gastroesophageal reflux disease after peroral endoscopic myotomy: Facts and fictions

        Amit Maydeo,Gaurav Patil 소화기인터벤션의학회 2020 Gastrointestinal Intervention Vol.9 No.2

        Peroral endoscopic myotomy (POEM) has today evolved to be the gold standard for the treatment of achalasia cardia and other spastic esophageal disorders. Its minimal invasive nature, safety and encouraging outcomes have made POEM the most commonly practiced submucosal tunneling procedure. Gastroesophageal reflux disease (GERD) or abnormal esophageal acid exposure time (AET), however, continues to haunt and dampen the encouraging clinical outcome after a POEM procedure. This is mainly because as against a laparoscopic Heller’s myotomy, the procedure of POEM is not combined with an anti-reflux procedure. The incidence of GERD or AET after the POEM procedure has been shown to be, however, dissimilar in various studies. This is probably due to the inconsistency in the definitions of GERD and AET seen on 24-hr-pH studies. It is a known fact that continued abnormal esophageal acid exposure can lead to erosive esophagitis, Barrett’s metaplasia, and esophageal cancer in the long run. Current literature also suggests that almost 50% of patients do develop abnormal acid exposure after a POEM procedure though only around one third develop symptoms or have erosive esophagitis. This concern has led to the development of techniques like POEM with fundoplication wherein an endoscopic fundoplication is performed in the same sitting of the POEM procedure, or even some techniques of endoscopic full-thickness plication/trans-oral incisionless fundoplication which can be performed after the POEM procedure selectively. Given the fact that almost 50% of patients undergoing POEM do develop an abnormal acid exposure, it is imperative that we need to clearly develop a rational strategy to deal with this reality. This review aims to realign the facts and fictions of the menace of post-POEM GERD and suggest a rational algorithmic approach.

      • KCI등재

        Gastroesophageal reflux disease after peroral endoscopic myotomy: Facts and fictions

        Amit Maydeo,Gaurav Patil 소화기인터벤션의학회 2020 International journal of gastrointestinal interven Vol.9 No.2

        Peroral endoscopic myotomy (POEM) has today evolved to be the gold standard for the treatment of achalasia cardia and other spastic esophageal disorders. Its minimal invasive nature, safety and encouraging outcomes have made POEM the most commonly practiced submucosal tunneling procedure. Gastroesophageal reflux disease (GERD) or abnormal esophageal acid exposure time (AET), however, continues to haunt and dampen the encouraging clinical outcome after a POEM procedure. This is mainly because as against a laparoscopic Heller’s myotomy, the procedure of POEM is not combined with an anti-reflux procedure. The incidence of GERD or AET after the POEM procedure has been shown to be, however, dissimilar in various studies. This is probably due to the inconsistency in the definitions of GERD and AET seen on 24-hr-pH studies. It is a known fact that continued abnormal esophageal acid exposure can lead to erosive esophagitis, Barrett’s metaplasia, and esophageal cancer in the long run. Current literature also suggests that almost 50% of patients do develop abnormal acid exposure after a POEM procedure though only around one third develop symptoms or have erosive esophagitis. This concern has led to the development of techniques like POEM with fundoplication wherein an endoscopic fundoplication is performed in the same sitting of the POEM procedure, or even some techniques of endoscopic full-thickness plication/trans-oral incisionless fundoplication which can be performed after the POEM procedure selectively. Given the fact that almost 50% of patients undergoing POEM do develop an abnormal acid exposure, it is imperative that we need to clearly develop a rational strategy to deal with this reality. This review aims to realign the facts and fictions of the menace of post-POEM GERD and suggest a rational algorithmic approach.

      • KCI등재

        Tin Layer as a Solid Lubricant for Cold Tube Drawing Processes

        Mahesh Patil,Varinder Singh,Amit Kumar Gupta,Srinivasa Prakash Regalla,Tufan Chandra Bera,Bade Simhachalam,Krishna Srinivas 한국정밀공학회 2022 International Journal of Precision Engineering and Vol.9 No.2

        This paper reports an investigation into the deployment of a thin layer of tin as a lubricant on low carbon steel tube for tube drawing process. The layer was deposited using electro-deposition technique using a green technology of citric acid based electrolyte bath. Coating layer is characterized using SEM, EDS and 3D digital microscopy technique before and after drawing processes. Experimental trials of drawing operation were conducted and promising results were observed with respect to drawing load and surface quality. The observed drawing load is comparable to that with the conventional lubrication system thereby proving the effectiveness of the new proposed lubrication system. The use of proposed lubrication resulted in greatly improved finish as well as better corrosion resistance yielding an additional promise for better value in service life, better market potential as well as a gain on environment front as the proposed method has the potential to eliminate some after operations after drawing as the drawn tube is ready to use after drawing operation.

      • KCI등재
      • SCOPUSKCI등재
      • A PROSPECTIVE STUDY OF REAL TIME IDENTIFICATION OF LINE OF TRANSECTION IN ROBOTIC RECTAL CANCER SURGERY BY ICG

        Priya Kapoor,Somashekhar SP,Shabber Zaveri,Amit Rauthan,Poonam Patil,Ashwin KR,Rohit Kumar 대한종양외과학회 2021 대한임상종양학회 학술대회지 Vol.2021 No.6

        Background/Aims Colorectal anastomosis carries a high risk of leak from 1 to 30 %. Of the many risk factors, lack of anastomotic blood supply is a correctable cause during surgery. With the development of ICG enhanced fluorescence guided imaging system capable of real time monitoring, objective assessment of blood flow to colon has become possible. We believed not only surgical experts but also beginners would be able to draw safe transection lines during surgery Methods Prospective study – October 2018 to August 2019. After distal transection, the line of proximal transection of the bowel was subjectively assessed by the surgical team and marked point B. Volume injected - 3 ml of ICG in a concentration of 2.5mg/ml IV followed by 10ml of distilled water flush. The line of demarcation was identified in the firefly mode and marked point A if it was proximal to clinical judgement point (point B) and as point C if it moved distally. The perfusion images were recorded and assessed in real time. Results Total number of patients was 50. The average Age of the patients was 54years. 32 were male and 18 were female. Line of transection moved proximally in 3 patients, distally in 41 patients and remained the same in 6 patients. Intraoperative decision changed in 88% of our patients Conclusions It has changed the intra operative decision in 88% of our patients. Can avoid anastomotic failure. Splenic flexure mobilisation could have been avoided in 82% of patients. This resolves the ambiguity of precarious blood supply of sigmoid. It is technically easy, reproducible and safe and larger studies are needed to provide evidence for its routine use in robotic rectal cancer surgery.

      • KCI등재

        A Comprehensive Review on Potential Application of Nanomaterials in the Field of Agricultural Engineering

        Chowdhury Manojit,Kushwah Ajay,Satpute Ajay N.,Singh Sanjay Kumar,Patil Amit Kumar 한국농업기계학회 2023 바이오시스템공학 Vol.48 No.4

        Purpose The purpose of this study is to explore the utilization of nanomaterials in the agricultural engineering sector and to understand their potential to contribute to sustainable growth in agriculture. Methods This comprehensive review paper synthesizes existing research and examines the integration of nanomaterials in various aspects of agricultural engineering. It delves into how nanomaterials can enhance the efficiency and performance of agricultural machinery, prime movers, tire technology, lubrication systems, coolant formulations, irrigation methods, plant protection strategies, fertilizer application mechanisms, and food processing techniques. The study also considers potential health and safety risks associated with nanotechnology in agriculture. Results The results of this review paper highlight the extensive potential of nanomaterials in revolutionizing agricultural practices. Nanotechnology has the capacity to significantly improve agricultural processes, making them more efficient and sustainable. The integration of nanomaterials in various agricultural components and processes has shown promising outcomes. However, it also underscores the need for ongoing research to address potential health and safety risks. Conclusion Incorporation of nanomaterials in agriculture holds great promise for sustainable growth and efficiency. It offers innovative solutions to enhance various aspects of agricultural engineering. While nanomaterials have the potential to revolutionize agriculture, it is crucial to proceed with caution and conduct continued research to mitigate potential health and safety risks. As agriculture seeks more efficient and sustainable practices, the integration of nanomaterials remains a frontier that necessitates ongoing exploration and vigilance in its implementation.

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