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- 저자 : Bharat Bhandari (검색결과 3 건)
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Deepanshu Jain,Bharat Singh Bhandari,Nikhil Agrawal,Shashideep Singhal 대한소화기내시경학회 2018 Clinical Endoscopy Vol.51 No.5
Surgery remains the standard treatment for acute cholecystitis except in high-risk candidates where percutaneous transhepatic gallbladderdrainage (PT-GBD), endoscopic transpapillary cystic duct stenting (ET-CDS), and endoscopic ultrasound-guided gallbladder drainage(EUS-GBD) are potential choices. PT-GBD is contraindicated in patients with coagulopathy or ascites and is not preferred by patientsowing to aesthetic reasons. ET-CDS is successful only if the cystic duct can be visualized and cannulated. For 189 patients whounderwent EUS-GBD via insertion of a lumen-apposing metal stent (LAMS), the composite technical success rate was 95.2%, which increasedto 96.8% when LAMS was combined with co-axial self-expandable metal stent (SEMS). The composite clinical success rate was96.7%. We observed a small risk of recurrent cholecystitis (5.1%), gastrointestinal bleeding (2.6%) and stent migration (1.1%). Cauteryenhanced LAMS significantly decreases the stent deployment time compared to non-cautery enhanced LAMS. Prophylactic placementof a pigtail stent or SEMS through the LAMS avoids re-interventions, particularly in patients, where it is intended to remain in situ indefinitely. Limited evidence suggests that the effcacy of EUS-GBD via LAMS is comparable to that of PT-GBD with the former showingbetter results in postoperative pain, length of hospitalization, and need for antibiotics. EUS-GBD via LAMS is a safe and effcaciousoption when performed by experts.
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Endoscopic Sleeve Gastroplasty - A New Tool to Manage Obesity
Deepanshu Jain,Bharat Singh Bhandari,Ankit Arora,Shashideep Singhal 대한소화기내시경학회 2017 Clinical Endoscopy Vol.50 No.6
Obesity is a growing pandemic across the world. Dietary restrictions and behavior modifications alone have a limited benefit. Bariatric surgery, despite being the current gold standard, has limited acceptance by patients due to cost and associated morbidity. In our review, we have discussed nine original studies describing endoscopic sleeve gastroplasty (ESG). A total of 172 subjects successfully underwent ESG. Of 65 subjects with follow up data, 95.4% (62/65) had intact gastric sleeve confirmed via esophagogastroduodenoscopy or oral contrast study at the end of study specific follow up interval (the longest being 6 months). Individual studies reported a technical success rate for intact gastric sleeve from as low as 50% to as high as 100%. A statistically significant (p<0.05) weight loss was reported in seven of the eight studies with available data. None of the patients experienced any intra-procedure complications, and approximately 2.3% (4/172) of patients experienced major post-procedure complications; however, no mortality was reported. Majority of the studies reported relatively high incidence of minor post-procedure complications, which improved with symptomatic treatment alone. Good patient tolerance with comparable clinical efficacy in achieving and sustaining desired weight loss makes ESG an attractive option to consider among other bariatric therapies.
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Closing the Gaps: Endoscopic Suturing for Large Submucosal and Full-Thickness Defects
Keshav Kukreja,Suma Chennubhotla,Bharat Bhandari,Ankit Arora,Shashideep Singhal 대한소화기내시경학회 2018 Clinical Endoscopy Vol.51 No.4
This article is a systematic review of relevant literature on endoscopic suturing as a primary closure technique for large submucosaland full-thickness defects after endoscopic mucosal resection (EMR), endoscopic submucosal dissection (ESD), and endoscopic fullthicknessresection (EFTR). A comprehensive literature search was conducted through 2016 by using PubMed, to find peer-reviewedoriginal articles. The specific factors considered were the procedural indications and details, success rates, clinical outcomes includingcomplications, and study limitations. Six original articles were included in the final review: two with non-human subjects and fourwith human subjects. The mean success rate of endoscopic suturing was 97.4% (100% for human subjects and 95.4% for non-humansubjects). The procedural time ranged from 7 to 89 min. The average size and depth of lesions were 2.71 cm (3.74 cm [human] and1.96 cm [non-human]) and 1.52 cm, respectively. The technique itself had no reported impact on mortality. In conclusion, endoscopicsuturing is a minimally invasive technique for the primary closure of defects caused by EMR, ESD, and EFTR, with a high success andlow complication rate.
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