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   Table of Contents - Current issue
October-December 2018
Volume 9 | Issue 4
Page Nos. 145-216

Online since Monday, February 11, 2019

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Routine screening before endoscopic procedures: A systematic review Highly accessed article p. 145
Gajanan Ashokrao Rodge, Mahesh Kumar Goenka
Routine screening prior to endoscopic procedures includes ordering a panel of tests on all patients undergoing endoscopic procedures without seeking any history and physical examination of the patients. These laboratory testing increases the cost burden on the patient but can have a strong impact on complications after endoscopic procedures. Selective preoperative tests (i.e., tests ordered after consideration of careful history taking and physical examination) may assist in making decisions about the process of perioperative assessment and management. We believe that the Society of Gastrointestinal Endoscopy of India should take initiative to draw its own position paper / guideline in view of the strong impact on cost and medico-legal issue in an Indian setting.
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Thickened gastric folds: Approach Highly accessed article p. 149
Roshan Agarwala, Jimil Shah, Usha Dutta
Thickened gastric folds (TGF) are not an uncommon finding on radiological imaging or endoscopy. It is an enigmatic condition requiring a systematic approach with correlation between clinical, laboratory, radiological, endoscopic, and histological parameters to reach a final diagnosis. It has a varied number of differential diagnosis and reaching the final diagnosis is often challenging even to an astute clinician. Findings on endoscopy are similar and biopsy results often equivocal. Differentiating between benign and malignant conditions is challenging. Routine pinch biopsy usually does not sample deep enough to get an adequate tissue sample, and other methods of biopsy may be required. Newer modalities, such as endoscopic ultrasound (EUS) and EUS-guided sampling, are helpful in differentiating benign from malignant causes. At times, exploratory laparotomy and full-thickness biopsy may be required for final diagnosis. In this review, we discuss the various differentials of TGF, with special emphasis on how to approach a case of TGF.
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Clinical profile, complications, management, and outcome of post-endoscopic retrograde cholangiopancreatography pancreatitis: A North Indian study p. 155
Mudasir Habib, Hilal Ahmad Dar, Mushtaq Ahmad Khan, Altaf Hussain Shah, Showkat Ali Zargar, Bhagat Singh, Nadeem Ahmad Sheikh, Aadil Ashraf, Sozia Mohammad
Aim: The aim of this study was to assess clinical profile, complications, management, and outcome of postendoscopic retrograde cholangiopancreatography (ERCP) pancreatitis. Methods: In this prospective study, 1320 patients were followed for the development of post-ERCP pancreatitis. Post-ERCP complications and outcome were assessed. Results: The percentage of post-ERCP pancreatitis in our patients was 5.3%. The mean age of patients with post-ERCP pancreatitis was 49.9 years. About 15.7% of the patients who developed post-ERCP pancreatitis experienced complications in the form of respiratory failure and sepsis. Conclusion: The incidence of post-ERCP pancreatitis was 5.3%. The major complications after post-ERCP pancreatitis were respiratory failure and sepsis. The outcome of post-ERCP pancreatitis was good, as there was no mortality. However, majority of patients with severe post-ERCP pancreatitis developed sepsis and received antibiotics.
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A clinical study of the use of savary-gilliard dilators in corrosive esophageal strictures without the use of fluoroscopy: A reality in resource-limited settings in a developing country p. 159
Varsha Rajat Bhatt, Arjun Lal Kakrani
Context: Corrosive compounds are either acids or alkalis, and their ingestion can cause esophageal strictures which may be tortuous and multiple. Aims: The aim of study was to assess therapeutic efficacy and safety of dilatation using Savary-Gilliard dilators in these patients without the use of fluoroscopy. Settings and Design: A cross-sectional observational study, conducted for 18 months in a tertiary care teaching hospital in Western India. Subjects and Methods: Ten dysphagic patients who had a history of corrosive ingestion 2 months or more before presentation, who had documented esophageal strictures on endoscopy were included. Barium swallow and endoscopy confirmed the site, length, and number of strictures. Dilatation with Savary-Gilliard dilators was done without the use of fluoroscopy with the help of guide wire in ”rule of threes.” Patients were followed up immediately and for 12 months. Descriptive statistics, mean, and SD were applied in EPI info version 7 software. Results: The mean age of 29 + 6.5 years and 70% were females. About 80% had dysphagia Grades III and IV. On endoscopy, 40% had strictures at multiple sites and 60% of patients had strictures more than 5 cm in length. 50% strictures were very tight. Number of patients in whom there was the passage of one dilator more than the stricture in the first session were 80%. A mean of 8.28 sessions of dilatation were required. Adequate dysphagia relief was achieved in 8 (80%) patients, while there were 2 failures. A total of 180 dilatations were performed on these 10 patients of corrosive strictures over a period of 12 months. One minor perforation occurred in this study. Conclusions: In resource-limited settings such as India, dilatation without fluoroscopy can be considered as effective and safe initial management for corrosive strictures.
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Endoscopic sleeve gastroplasty for obesity – First Indian experience: Case series and review of literature p. 165
Nitin Jagtap, Rakesh Kalapala, Abhishek Katakwar, Santosh Darishetty, D Nageshwar Reddy
Introduction: In India, obesity affects >135 million and leads to nearly 5.8 million deaths per year. Some of the unmet need in the management of obesity can be fulfilled by endoscopic therapies such as endoscopic sleeve gastroplasty (ESG). Methods: In this case series, we report our preliminary experience of ESG in three obese patients. We recorded baseline demographic data, total procedural time, adverse events, and percentage total body weight loss (%TBWL) up to 20 weeks. Results: All three patients were male with a median age of 29 years (range 26–39) with a median body mass index of 34.28 kg/m2 (range 32.60–37.13). A total of four full-thickness and additional three submucosal sutures were applied in each patient. There were no adverse events. The median total procedural time was 105 min (range 90–150). All patients were discharged within 48 h. The median percentage total body weight loss (%TBWL) at 12 weeks was 12.02 (range 10.85–13.33) and at 16 weeks was 14.23 (range 13.84–14.62). The maximum follow-up so far is 20 weeks (one patient) with %TBWL of 16.38. Conclusion: In our preliminary experience, we conclude that ESG is safe, effective and requires shorter hospital stay. In short-term follow-up, there is adequate weight loss without major adverse events.
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Capsule endoscopy for obscure gastrointestinal bleeding: A single-center experience p. 168
Virender Chauhan, Vasudha Goel, Mukesh Jain, Gaurav Gupta, Rupesh Pokharna, Shyam Sunder Sharma, Sandeep Nijhawan
Background: Capsule endoscopy (CE) has an established role in evaluating obscure gastrointestinal bleeding (OGIB). The aim was to know the diagnostic yield of CE and spectrum of OGIB. Materials and Methods: In this retrospective study, we evaluated all the patients with obscure gastrointestinal bleed using MiroCam capsule endoscope (IntroMedic, Seoul, Korea) between February 2014 and March 2018. Clinical data, ancillary investigations, and response to specific treatment were considered to confirm CE findings. Results: Out of 102 patients included in the study (mean age 54.5 ± 16.1 years, male: female ratio = 1.83:1) OGIB-overt and OGIB-occult was present in 46 and 56 patients, respectively. Diagnostic yield of CE was similar in both the groups (overt-37/46, 80.4% versus occult-37/56, 66.5%) (P ≥ 0.05), although there was trend to find more lesions in overt group. Overall positive diagnostic yield was 72.5%. Lesions detected were vascular malformations in 21 (20.5%), nonsteroidal anti-inflammatory drug enteropathy in 13 (12.7%), small bowel ulcerations in 27 (26.4%), which were further divided into three subgroups (a) nonspecific ulcerations 11 (10.7%), (b) tubercular ulcer with/without stricture in 7 (6.8%) and (c) serpiginous ulcers and fissuring with cobble-stone appearance suggestive of Crohn's disease in 9 (8.8%), portal hypertensive enteropathy in 5 (4.9%), worm infestation (hookworms in 3, roundworms 1) in 4 (3.9%), and small bowel tumour in 1 (0.98%) patient. Overall, 56.7% patients were having definitive (P2) lesions (Saurin classification). Two patients had retention of capsule, but none developed intestinal obstruction. Capsule was removed with surgical intervention. Conclusion: CE has high diagnostic yield, relative safety and tolerability, and it is an important diagnostic tool for OGIB. Small bowel tuberculosis, Crohn's disease and Worm infestation continue to be commonly recognized causes of OGIB in developing countries like India.
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Post endoscopic retrograde cholangiopancreatography pancreatitis: Bitter pill for endoscopists to swallow p. 176
HS Yashavanth, Mohan Ramchandani
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Fluoroscopy during esophageal stricture dilatation: Can it be considered optional? p. 178
Saroj Kant Sinha, R Kochhar
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Endo-bariatrics: Are we ready? p. 181
Sundeep Lakhtakia
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The journey of capsule endoscopy in India p. 183
Rajesh Gupta
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Complicated cases of lithium battery ingestion: Delay can be deadly p. 184
Arya Suchismita, Ravish Ranjan, Ashish Kumar Jha, Praveen Jha, Madhur Choudhary, Vishwa Mohan Dayal, Kuldeep Sehrawat
Increasing use of button battery (BB) in household products and toys is responsible for the growing incidence of button battery ingestion (BBI). The BBI may cause life-threatening complications. We present a series of three cases of complicated BBI (lithium cell) with delayed presentation; one of them could not survive due to tracheoesophageal fistula and sepsis. Here, we highlight the importance of early endoscopic intervention and careful follow-up in children with lithium battery ingestion.
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Tracheoesophageal fistula: Bridging the gap by over-the-scope clip services p. 188
Avinash Bhat Balekuduru, Siddharth Dhande, Lokesh Locheruvapalli Venkateshappa, Satyaprakash Bonthala Subbaraj
Tracheoesophageal fistula (TOF) can be congenital or acquired. Acquired TOF can be caused by iatrogenic or traumatic or due to malignancy with pulmonary infection or aspiration being the presenting symptom. Management of TOF is associated with high mortality and morbidity and remains an interdisciplinary challenge. In general, depending on the size and location of the tracheal aspect of the fistula, surgical therapy involves primary repair of the fistula and, if necessary, resection and reconstruction of the trachea. We present two cases of iatrogenic TOF following surgery successfully closed using over-the-scope clips. This report also compares both the Ovesco and Padlock clip devices.
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Duodenal perforation secondary to migrated biliary stent: A rare and serious complication of endoscopic retrograde cholangiopancreatography p. 193
Vipul D Yagnik, Vismit P Joshipura
Although migration of biliary stents is not uncommon, stent-induced perforation of the intestinal wall is a rare and serious complication. We report a case of duodenal perforation secondary to migrated biliary stent kept for obstructive jaundice for common bile duct stone in a 64-year-old male. Intestinal perforation secondary to migrated stent should be considered in patients reported with abdominal pain and sepsis after an endoscopic retrograde cholangiopancreatography with biliary stent placement.
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Carcinoma colon in a patient with eosinophilic gastroenteritis p. 196
Rachit Agarwal, Piyush Ranjan, Sunita Bhalla
Eosinophilic gastroenteritis is an uncommon disease which can involve all layers of the gastrointestinal tract anywhere from the esophagus to colon. Clinical features depend upon the site of involvement and layer of GI tract involved. It is an inflammatory disease with remitting and relapsing course. We report a case which presented with discharging fecal fistula in lower abdomen after emergency laparotomy. Initial colonoscopy showed stricture with nodularity of the IC junction and biopsy showed features of eosinophilic gastroenteritis. Due to persistence of fistula he underwent right hemicolectomy with illeo-transverse anastomosis. Biopsy from surgical specimen showed well differentiated adenocarcinoma and eosinophilic infiltrate in muscularis. Surveillance colonoscopy done six months later showed ulcer at anastomotic site and biopsy showed features of eosinophilic colitis. The clinical course of this patient circumstantially indicates a linkage of eosinophilic colitis with carcinoma colon. This is the first reported case of association of eosinophilic colitis with carcinoma colon. We discuss in detail the clinical and pathological features of eosinophilic enteritis and possible mechanisms linking eosinophilc enteritis with carcinoma.
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Endoscopic management of an iatrogenic colonic perforation using standard hemoclips p. 201
Sanjeev Kumar, Saket Kumar, Sujit Kumar, Vijay Prakash
Iatrogenic colonic perforation is an unusual but life-threatening complication of colonoscopy. The recent advancement in endoscopy technology has made nonoperative treatment a safe and effective option for managing such perforations. A 70-year-old man sustained an iatrogenic sigmoid perforation during diagnostic colonoscopy. The abdominal X-ray showed free gas under diaphragm. He was started on conservative management and intravenous antibiotics. He underwent a second colonoscopy after 2.5-h, perforation was identified and closed with standard hemoclips. He recovered well and was discharged from hospital 6 days later. There are only a handful of reports in the medical literature describing successful outcomes following endoscopic management. Most of the cases have been managed with over-the-scope clips or endoscopic sutures that are quite expensive. In the present report, an iatrogenic sigmoid perforation was managed endoscopically with standard hemoclips. The hemoclip can be an effective, yet economical method of perforation repair in selected cases.
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Coil migration into common bile duct after postcholecystectomy hepatic artery pseudo-aneurysm coiling p. 205
Mukesh Nasa, Zubin Dev Sharma, Gaurav Patil, Rajesh Puri
We report an interesting case of 50-year-old female who had postcholecystectomy hepatic artery pseudoaneurysm. This pseudo-aneurysm was coiled by interventional radiologist. Patient later presented with obstructive jaundice which was due to migration of pseudoaneurysm coils into bile-duct.
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Endoscopic ultrasound detection of active bleeding during endoscopic transmural drainage of walled-off necrosis p. 208
Surinder Singh Rana, Ravi Sharma, Rajesh Gupta
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Gastric lesion in a patient with advanced hepatocellular carcinoma p. 210
Subhash Chandra Tiwari, Rachit Agarwal, MK Goenka
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Dunning–Kruger effect, stages of competence, and the need for endoscopy training p. 211
Sridhar Sundaram
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Endoscopic ultrasound-guided diagnosis of pancreatic cystic lesions: Microforceps or molecular markers! p. 213
Ravi Kumar Sharma, Surinder Singh Rana
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