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Giri S, Mohan BP, Jearth V, Kale A, Angadi S, Afzalpurkar S, Harindranath S, Sundaram S. Adverse events with EUS-guided biliary drainage: a systematic review and meta-analysis. Gastrointest Endosc 2023; 98:515-523.e18. [PMID: 37392952 DOI: 10.1016/j.gie.2023.06.055] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 06/01/2023] [Accepted: 06/20/2023] [Indexed: 07/03/2023] [Imported: 08/29/2023]
Abstract
BACKGROUND AND AIMS Multiple meta-analyses have evaluated the technical and clinical success of EUS-guided biliary drainage (BD), but meta-analyses concerning adverse events (AEs) are limited. The present meta-analysis analyzed AEs associated with various types of EUS-BD. METHODS A literature search of MEDLINE, Embase, and Scopus was conducted from 2005 to September 2022 for studies analyzing the outcome of EUS-BD. The primary outcomes were incidence of overall AEs, major AEs, procedure-related mortality, and reintervention. The event rates were pooled using a random-effects model. RESULTS One hundred fifty-five studies (7887 patients) were included in the final analysis. The pooled clinical success rates and incidence of AEs with EUS-BD were 95% (95% confidence interval [CI], 94.1-95.9) and 13.7% (95% CI, 12.3-15.0), respectively. Among early AEs, bile leak was the most common followed by cholangitis with pooled incidences of 2.2% (95% CI, 1.8-2.7) and 1.0% (95% CI, .8-1.3), respectively. The pooled incidences of major AEs and procedure-related mortality with EUS-BD were .6% (95% CI, .3-.9) and .1% (95% CI, .0-.4), respectively. The pooled incidences of delayed migration and stent occlusion were 1.7% (95% CI, 1.1-2.3) and 11.0% (95% CI, 9.3-12.8), respectively. The pooled event rate for reintervention (for stent migration or occlusion) after EUS-BD was 16.2% (95% CI, 14.0-18.3; I2 = 77.5%). CONCLUSIONS Despite a high clinical success rate, EUS-BD may be associated with AEs in one-seventh of the cases. However, major AEs and mortality incidence remain less than 1%, which is reassuring.
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Giri S, Afzalpurkar S, Angadi S, Marikanty A, Sundaram S. Comparison of suction techniques for EUS-guided tissue acquisition: Systematic review and network meta-analysis of randomized controlled trials. Endosc Int Open 2023; 11:E703-E711. [PMID: 37564335 PMCID: PMC10411163 DOI: 10.1055/a-2085-3674] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Accepted: 04/12/2023] [Indexed: 08/12/2023] [Imported: 08/29/2023] Open
Abstract
Background and study aims Despite the widespread use of endoscopic ultrasound (EUS)-guided tissue acquisition, the choice of optimal suction technique remains a subject of debate. Multiple studies have shown conflicting results with respect to the four suction techniques: Dry suction (DS), no suction (NS), stylet slow-pull (SSP) and wet suction (WS). Thus, the present network meta-analysis (NMA) was conducted to compare the diagnostic yields of above suction techniques during EUS-guided tissue acquisition. Methods A comprehensive literature search from 2010 to March 2022 was done for randomized trials comparing the aspirated sample and diagnostic outcome with various suction techniques. Both pairwise and network meta-analyses were performed to analyze the outcomes: sample adequacy, moderate to high cellularity, gross bloodiness and diagnostic accuracy. Results A total of 16 studies (n=2048 patients) were included in the final NMA. WS was associated with a lower odd of gross bloodiness compared to DS (odds ratio 0.50, 95% confidence interval 0.24-0.97). There was no significant difference between the various suction methods with respect to sample adequacy, moderate to high cellularity and diagnostic accuracy. On meta-regression, to adjust for the effect of needle type, WS was comparable to DS in terms of bloodiness when adjusted for fine-needle aspiration needle. Surface under the cumulative ranking analysis ranked WS as the best modality for all the outcomes. Conclusions The present NMA did not show superiority of any specific suction technique for EUS-guided tissue sampling with regard to sample quality or diagnostic accuracy, with low confidence in estimates.
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Giri S, Angadi S, Afzalpurkar S, Harindranath S, Varghese J, Sundaram S. Diagnostic performance and safety of endoscopic ultrasound-guided tissue acquisition of gallbladder lesions: A systematic review with meta-analysis. Indian J Gastroenterol 2023; 42:467-474. [PMID: 37280409 DOI: 10.1007/s12664-023-01374-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Accepted: 04/15/2023] [Indexed: 06/08/2023] [Imported: 08/29/2023]
Abstract
BACKGROUND Endoscopic ultrasound (EUS)-guided tissue acquisition (TA) is widely used for various target samples, but its efficacy in gallbladder (GB) lesions is unknown. The aim of the present meta-analysis was to assess the pooled adequacy, accuracy and safety of EUS-TA of GB lesions. METHODS A literature search from January 2000 to August 2022 was done for studies analyzing the outcome of EUS-guided TA in patients with GB lesions. Pooled event rates were expressed with summative statistics. RESULTS The pooled rate of sample adequacy for all GB lesions and malignant GB lesions was 97.0% (95% CI: 94.5-99.4) and 96.6% (95% CI: 93.8-99.3), respectively. The pooled sensitivity and specificity for the diagnosis of malignant lesions were 90% (95% CI: 85-94; I2 = 0.0%) and 100% (95% CI: 86-100; I2 = 0.0%), respectively, with an area under the curve of 0.915. EUS-guided TA had a pooled diagnostic accuracy rate of 94.6% (95% CI: 90.5-96.6) for all GB lesions and 94.1% (95% CI: 91.0-97.2) for malignant GB lesions. There were six reported mild adverse events (acute cholecystitis = 1, self-limited bleeding = 2, self-limited episode of pain = 3) with a pooled incidence of 1.8% (95% CI: 0.0-3.8) and none of the patients had serious adverse events. CONCLUSION EUS-guided tissue acquisition from GB lesions is a safe technique with high sample adequacy and diagnostic accuracy. EUS-TA can be an alternative when traditional sampling techniques fail or are not feasible.
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Harindranath S, Sundaram S. Approach to Pancreatic Head Mass in the Background of Chronic Pancreatitis. Diagnostics (Basel) 2023; 13:diagnostics13101797. [PMID: 37238280 DOI: 10.3390/diagnostics13101797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 05/12/2023] [Accepted: 05/17/2023] [Indexed: 05/28/2023] [Imported: 08/29/2023] Open
Abstract
Chronic pancreatitis (CP) is a known risk factor for pancreatic cancer. CP may present with an inflammatory mass, and differentiation from pancreatic cancer is often difficult. Clinical suspicion of malignancy dictates a need for further evaluation for underlying pancreatic cancer. Imaging modalities remain the mainstay of evaluation for a mass in background CP; however, they have their shortcomings. Endoscopic ultrasound (EUS) has become the go-to investigation. Adjunct modalities such as contrast-harmonic EUS and EUS elastography, as well as EUS-guided sampling using newer-generation needles are useful in differentiating inflammatory from malignant masses in the pancreas. Paraduodenal pancreatitis and autoimmune pancreatitis often masquerade as pancreatic cancer. In this narrative review, we discuss the various modalities used to differentiate inflammatory from malignant masses of the pancreas.
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Sundaram S, Chhanchure U, Patil P, Seth V, Mahajan A, Bal M, Kaushal RK, Ramadwar M, Prabhudesai N, Bhandare M, Shrikhande SV, Mehta S. Rapid on-site evaluation (ROSE) versus macroscopic on-site evaluation (MOSE) for endoscopic ultrasound-guided sampling of solid pancreatic lesions: a paired comparative analysis using newer-generation fine needle biopsy needles. Ann Gastroenterol 2023; 36:340-346. [PMID: 37144017 PMCID: PMC10152805 DOI: 10.20524/aog.2023.0790] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 01/23/2023] [Indexed: 05/06/2023] [Imported: 08/29/2023] Open
Abstract
Background Rapid on-site examination (ROSE) during endoscopic ultrasound-guided fine needle biopsy (EUS-FNB) has been a subject of debate. We compared the yield of EUS-FNB with adequacy assessed using macroscopic on-site evaluation (MOSE), and smear cytology with adequacy confirmed by ROSE, acquired using the same needle. Methods Consecutive patients with solid pancreatic lesions (SPLs) who underwent EUS-FNB of pancreatic solid lesions between January 2021 and July 2022 were included. Demographic details, site and size of lesion, number of passes, and the diagnosis by cytology and histopathology of core tissue were noted. The first pass was used for ROSE adequacy assessment and was subsequently sent for cytological assessment. Additional passes were taken subsequently to acquire core tissue. Adequacy was confirmed by MOSE (whitish core of more than 4 mm). Final cytology and histopathology (HPE) were compared for diagnostic accuracy. Results One hundred fifty-five patients were included in the analysis during the study period (mean age 55.1+12.9 years; 60% male; 77% in pancreatic head; median size 3.7 cm). The final diagnosis was malignancy in 129, while 26 were negative for malignancy. Sensitivity and specificity for ROSE with cytology in detecting malignant SPLs were 96.9% and 100%, respectively. HPE with MOSE had sensitivity and specificity of 96.1% and 100%, respectively. A comparison of diagnostic accuracy showed no significant difference (P>0.99) between HPE with MOSE and ROSE with cytology, using an FNB needle. Conclusion MOSE is as good as ROSE in terms of diagnostic yield for solid pancreatic lesions sampled using newer-generation EUS biopsy needles.
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Giri S, Kolhe K, Sundaram S. Risk of post-ERCP pancreatitis is increased in patients with end-stage renal disease - a meta-analysis. Clin Res Hepatol Gastroenterol 2023; 47:102112. [PMID: 36918111 DOI: 10.1016/j.clinre.2023.102112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 02/28/2023] [Accepted: 03/10/2023] [Indexed: 03/16/2023] [Imported: 08/29/2023]
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Giri S, Angadi S, Afzalpurkar S, Nanjegowda SK, Bhrugumalla S, Sundaram S. Transesophageal endoscopic ultrasound-guided tissue acquisition of lung masses: a case series with systematic review and meta-analysis. Ann Gastroenterol 2023; 36:185-194. [PMID: 36864937 PMCID: PMC9932857 DOI: 10.20524/aog.2023.0778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2022] [Accepted: 01/02/2023] [Indexed: 02/05/2023] [Imported: 08/29/2023] Open
Abstract
Background The diagnosis of intraparenchymal lung masses is challenging when lesions are located at sites inaccessible through bronchoscopy or endobronchial ultrasound. Endoscopic ultrasound (EUS)-guided tissue acquisition (TA)-fine-needle aspiration (FNA) or fine-needle biopsy-provides a potentially useful diagnostic tool for lesions located adjacent to the esophagus. This study was conducted to analyze the diagnostic outcome and safety of EUS-guided tissue sampling of lung masses. Methods Data were retrieved for patients who underwent transesophageal EUS-guided TA between May 2020 and July 2022 at 2 tertiary care centers. A meta-analysis was performed after pooling these data with studies obtained from a comprehensive search of Medline, Embase, and ScienceDirect from January 2000 to May 2022. Pooled event rates across studies were expressed with summative statistics. Results After screening, 19 studies were identified and, after their data had been combined with those of 14 patients from our centers, a total of 640 patients were included in the analysis. The pooled rate of sample adequacy was 95.4% (95% confidence interval [CI] 93.1-97.8), while the pooled rate of diagnostic accuracy was 93.4% (95%CI 90.7-96.1). The pooled rate of adverse events with transesophageal EUS-guided TA from lung masses was 0.7% (95%CI 0.0-1.6%). There was no significant heterogeneity with respect to various outcomes and results were comparable on sensitivity analysis. Conclusions EUS-FNA offers a safe and accurate diagnostic modality for the diagnosis of paraesophageal lung masses. Future studies are needed to determine the needle type and techniques for improving outcomes.
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Giri S, Jearth V, Seth V, Darak H, Sundaram S. Comparison of efficacy and safety of endoscopic and radiological interventions for gastric varices: A systematic review and network meta-analysis. Clin Exp Hepatol 2023; 9:57-70. [PMID: 37064836 PMCID: PMC10090989 DOI: 10.5114/ceh.2023.126077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 01/14/2023] [Indexed: 04/18/2023] [Imported: 08/29/2023] Open
Abstract
Aim of the study There is a paradigm shift in the management of gastric varices with the availability of endoscopic ultrasound and radiologic interventions. The optimal choice of intervention remains a dilemma for most treating physicians. Material and methods We searched MEDLINE, the Cochrane Central Register of Controlled Trials, and ScienceDirect for studies comparing endoscopic glue injection, endoscopic thrombin injection (THB), variceal band ligation, EUS-guided coiling, EUS-guided glue injection, EUS-guided coiling with glue (EUS-C+G), balloon occluded retrograde transvenous obliteration (BRTO), and transjugular intrahepatic portosystemic shunt (TIPS) for gastric varices in adults. The data on four outcomes - obliteration of varices, rebleeding, adverse effects, and mortality - were pooled using a random-effects model. Treatment estimates were calculated as odds ratios (ORs) along with their 95% confidence interval (CI). The relative ranking of interventions for various outcomes was calculated as their surface under the cumulative ranking curve (SUCRA). Results We identified 34 studies (10 randomized controlled trials, 24 non-randomized trials) with 2783 patients. Based on SUCRA plots, BRTO (SUCRA 95.1) had the highest rate of variceal obliteration followed by EUS-C+G (SUCRA 80.9). The risk of rebleeding was lowest with BRTO (SUCRA 85.1) followed by EUS-C+G (SUCRA 78.8). Moderate-severe adverse effects were least likely with THB (SUCRA 92.5) and highest with TIPS (SUCRA 3.7). In terms of mortality, EUS-C+G (73.5) had the lowest probability of overall mortality followed by TIPS (69.1). Conclusions In this network meta-analysis, we found BRTO and EUS-guided therapies to be superior to endoscopic glue injection. However, the level of evidence remains low.
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Giri S, Afzalpurkar S, Angadi S, Varghese J, Sundaram S. Influence of biliary stents on the diagnostic outcome of endoscopic ultrasound-guided tissue acquisition from solid pancreatic lesions: a systematic review and meta-analysis. Clin Endosc 2023; 56:169-179. [PMID: 37013391 PMCID: PMC10073854 DOI: 10.5946/ce.2022.282] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 12/16/2022] [Indexed: 04/05/2023] [Imported: 08/29/2023] Open
Abstract
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-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. CONCLUSION The presence of a biliary stent may negatively affect the diagnostic outcome of EUS-TA for pancreatic lesions.
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Giri S, Afzalpurkar S, Anirvan P, Angadi S, Kasturi S, Varghese J, Sundaram S. Risk of Bleeding with Endoscopic Ultrasound-Guided Tissue Acquisition in Patients on Antithrombotic Therapy: A Systematic Review and Meta-Analysis. Dig Dis Sci 2023; 68:1950-1958. [PMID: 36609733 DOI: 10.1007/s10620-022-07808-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 12/17/2022] [Indexed: 01/09/2023] [Imported: 08/29/2023]
Abstract
BACKGROUND The present guidelines stratify endoscopic ultrasound-guided tissue acquisition (EUS-TA) as a high-bleeding risk procedure in patients on antithrombotics. However, the data regarding the same are conflicting. Therefore, this meta-analysis aimed to analyze the bleeding event rates associated with EUS-TA in patients receiving antithrombotic therapy. METHODS A literature search from January 2000 to August 2022 was done for studies on EUS-guided TA in patients receiving antithrombotics. The primary outcome was incidence of overall and major bleeding. Pooled event rates across studies were expressed with summative statistics. RESULTS A total of 12 studies were included in the meta-analysis. The pooled risk of overall bleeding and major bleeding in patients on antithrombotics was 2.0% (0.6-3.4) and 0.8% (0.0-1.6), respectively. In patients taking thienopyridine or anticoagulants, the pooled risk of overall bleeding and major bleeding was 2.4% (0.9-3.9) and 1.7% (0.4-3.1), respectively. Patients on antithrombotics had a higher odd of overall bleeding (OR 2.12, 1.20-3.83) and major bleeding (OR 3.58, 1.11-11.52) compared to controls. The odds of overall bleeding (OR 0.95, 95%CI 0.38-2.42) and major bleeding (OR 1.57, 95%CI 0.45-5.54) were comparable between patients on antithrombotics who continued and those who discontinued it preprocedural. CONCLUSION Despite an increase risk of bleeding with EUS-TA in patients on antithrombotics, the pooled incidence remains low. Compared to the previous guidelines stating thienopyridine use as high risk for bleeding, the present analysis showed a bleeding rate of less than 1%. Discontinuing antithrombotics prior to EUS-TA does not reduce the bleeding risk significantly, requiring strict monitoring.
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Sundaram S, Patra BR, Choksi D, Giri S, Kale A, Ramani N, Karad A, Shukla A. Outcomes and predictors of response to endotherapy in pancreatic ductal disruptions with refractory internal and high-output external fistulae. Ann Hepatobiliary Pancreat Surg 2022; 26:347-354. [PMID: 35995583 PMCID: PMC9721253 DOI: 10.14701/ahbps.22-002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 03/08/2022] [Accepted: 03/17/2022] [Indexed: 12/15/2022] [Imported: 08/29/2023] Open
Abstract
Backgrounds/Aims Endoscopic retrograde cholangiopancreatography (ERCP) remains the primary treatment for a subset of patients with pancreatic fistulae. The objective of this study was reporting outcomes of ERCP and predictors of resolution in patients with pancreatic fistulae refractory to conservative therapy. Methods Retrospective review of patients who underwent ERCP and pancreatic stent placement for pancreatic fistula not responding to medical therapy was performed. Clinical features, laboratory parameters, radiological features and pancreatogram findings were noted. Clinical resolution of fistula was the primary outcome measure. Results Sixty-eight patients underwent ERCP for high-output pancreatic fistula (Mean age 34.1 years, 91.1% males, 35/68 chronic pancreatitis, 52.9% alcohol etiology). Internal fistulae (pancreatic ascites, pleural effusion, or pericardial effusion) were seen in 55 (80.9%) patients and external fistula in 13 (19.1%) patients. Technical success for ERCP was 92.6% (63/68). Leak was seen in 98.4% (62/63). The most common leak site was body (69.8%). Multiple leak sites were seen in 23.1%. Pancreatic stricture was found in 36.5%. In 44 (69.4%) patients, stent was placed beyond the site of the leak. Resolution at six weeks was achieved in 76.4% (52/68). On univariate and multivariate analyses, placement of stent beyond site of leak was significantly associated with resolution of high-output fistulae (3/41 [7.3%] vs. 5/19 [26.3%], p = 0.03; odds ratio: 6.5, 95% confidence interval: 1.211-34.94). Conclusions In our experience, ERCP was successful in 76% of patients with pancreatic fistulae refractory to conservative therapy. Stent placement beyond the site of leak was associated with higher resolution of fistulae.
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Giri S, Jearth V, Darak H, Sundaram S. Outcomes of thin versus thick-wire snares for cold snare polypectomy: a systematic review and meta-analysis. Clin Endosc 2022; 55:742-750. [PMID: 36347525 PMCID: PMC9726435 DOI: 10.5946/ce.2022.141] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 06/27/2022] [Indexed: 11/11/2022] [Imported: 08/29/2023] Open
Abstract
BACKGROUND/AIMS Cold snare polypectomy (CSP) is commonly used for the resection of colorectal polyps ≤10 mm. Data regarding the influence of snare type on CSP effectiveness are conflicting. Hence, this meta-analysis aimed to compare the outcomes and safety of thin- and thick-wire snares for CSP. METHODS A comprehensive search of the literature published between 2000 and 2021 was performed of various databases for comparative 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-wire snare 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 the sensitivity analysis. CONCLUSION CSP using a thin-wire snare has no additional benefit over thick-wire snares in small colorectal polyps. Factors other than snare design may play a role in improving CSP outcomes.
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Giri S, Afzalpurkar S, Angadi S, Sundaram S. Mucosal incision-assisted biopsy versus endoscopic ultrasound-assisted tissue acquisition for subepithelial lesions: a systematic review and meta-analysis. Clin Endosc 2022; 55:615-625. [PMID: 36205045 PMCID: PMC9539302 DOI: 10.5946/ce.2022.133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Accepted: 06/16/2022] [Indexed: 11/30/2022] [Imported: 08/29/2023] Open
Abstract
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 interval [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 adverse events.
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Sundaram S, Patil P, Jain A, Chhanchure U, Ankathi SK, Khubchandani S, Mehta S. Endoscopic ultrasound-guided renal biopsy: an alternative to transjugular renal biopsy in high-risk patients. Endoscopy 2022; 54:E285-E286. [PMID: 34215009 DOI: 10.1055/a-1519-6365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022] [Imported: 08/29/2023]
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Sundaram S, Mane K, Tyagi U, Jain AK, Chhanchure U, Patil P, Mehta S. Endoscopic retrieval of a blocked double-pigtail plastic biliary stent through an endoscopic ultrasound-guided gastrojejunostomy in a patient with gastric outlet obstruction. Endoscopy 2022; 54:E806-E807. [PMID: 35523222 PMCID: PMC9735287 DOI: 10.1055/a-1824-4786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] [Imported: 08/29/2023]
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Kale A, Sundaram S, Satai M, Harindranath S, Garg L, Aggarwal M. EUS-guided pancreatic rendezvous for management of pancreaticopleural fistula with an undilated duct and pancreas divisum. Endosc Ultrasound 2022; 11:515-517. [PMID: 36537390 PMCID: PMC9921981 DOI: 10.4103/eus-d-21-00164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/14/2023] [Imported: 08/29/2023] Open
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Giri S, Jearth V, Sundaram S. Covered Self-Expanding Metal Stents Versus Multiple Plastic Stents for Benign Biliary Strictures: An Updated Meta-Analysis of Randomized Controlled Trials. Cureus 2022; 14:e24588. [PMID: 35651420 PMCID: PMC9138190 DOI: 10.7759/cureus.24588] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/29/2022] [Indexed: 11/05/2022] [Imported: 08/29/2023] Open
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Sundaram S, Giri S. Liver Diseases in the Parturient. Indian J Crit Care Med 2022; 25:S248-S254. [PMID: 35615617 PMCID: PMC9108777 DOI: 10.5005/jp-journals-10071-24027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] [Imported: 08/29/2023] Open
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Sundaram S, Choksi D, Kale A, Giri S, Patra B, Bhatia S, Shukla A. Outcomes of Dilation of Recalcitrant Pancreatic Strictures Using a Wire-Guided Cystotome. Clin Endosc 2021; 54:903-908. [PMID: 33657781 PMCID: PMC8652154 DOI: 10.5946/ce.2020.297] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Accepted: 01/05/2021] [Indexed: 11/29/2022] [Imported: 08/29/2023] Open
Abstract
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 Soehendra stent retriever or a needle knife described in case reports. Here, we discuss our experience with dilation of dominant pancreatic strictures with a 6-Fr cystotome.
Methods A retrospective review of an endoscopy database was performed to search for patients with pancreatic strictures recalcitrant to conventional methods of dilation in which a cystotome was used. Technical success was defined as the successful dilation of the stricture with 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 one had a pancreaticopleural fistula). The median stricture length was 10 mm (range, 5–25 mm). The head of the pancreas was the most common location of the stricture (60%). Technical and functional success was achieved in all patients. One patient had self-limiting bleeding, 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 pancreatic strictures after the failure of conventional modalities.
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Sundaram S, Dhir V. EUS-guided biliary drainage for malignant hilar biliary obstruction: A concise review. Endosc Ultrasound 2021; 10:154-160. [PMID: 34137381 PMCID: PMC8248311 DOI: 10.4103/eus-d-21-00004] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] [Imported: 08/29/2023] Open
Abstract
EUS-guided biliary drainage (EUS-BD) has emerged as an alternative to ERCP for distal biliary obstruction in expert hands. Various routes for EUS-guided access in distal biliary obstruction include EUS choledochoduodenostomy, EUS-guided rendezvous, and EUS-antegrade (EUS-AG) stent placement. While percutaneous transhepatic biliary drainage and ERCP are established modalities in management of malignant hilar biliary obstruction, the role of EUS-BD is emerging. Various methods of drainage in hilar obstruction include EUS hepaticogastrostomy, EUS hepaticoduodenostomy, EUS-guided bridging stent placement, and combined ERCP and EUS-guided biliary drainage. In this review, we discuss the role of EUS-BD in malignant hilar biliary obstruction with the currently available evidence, along with the limitations and challenges to the use of this modality in management of these patients.
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Sundaram S. Necrotizing pancreatitis after removal of prophylactically placed pancreatic stent. TURKISH JOURNAL OF GASTROENTEROLOGY 2019; 30:928-929. [PMID: 31625936 DOI: 10.5152/tjg.2018.18914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] [Imported: 08/29/2023]
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Gastric Amyloidosis Causing Nonvariceal Upper Gastrointestinal Bleeding. ACG Case Rep J 2019; 6:3-4. [PMID: 31341927 PMCID: PMC6650013 DOI: 10.14309/crj.0000000000000066] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Accepted: 02/28/2019] [Indexed: 12/28/2022] [Imported: 08/29/2023] Open
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Sundaram S, S K, Mazumdar S, Shukla A. Overlap Syndrome between Primary Biliary Cholangitis and Primary Sclerosing Cholangitis. ACG Case Rep J 2018; 5:e54. [PMID: 30038926 PMCID: PMC6053546 DOI: 10.14309/crj.2018.54] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2017] [Accepted: 05/02/2018] [Indexed: 02/02/2023] [Imported: 08/29/2023] Open
Abstract
Overlap syndrome indicates the coexistence of 2 or more autoimmune liver diseases in the same individual, occurring simultaneously or sequentially. Cases of overlap of autoimmune hepatitis (AIH) with primary biliary cholangitis (PBC) and of AIH with primary sclerosing cholangitis (PSC) are known and have defined criteria for diagnosis. Overlap between PBC and PSC has been reported in only a few case reports. The cause for the rarity of this entity compared to other overlap syndromes is unclear. We present a case of an overlap syndrome of PBC with PSC in a 35-year-old woman.
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