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Chhabra P, Bhasin DK. Risk assessment for Barrett's esophagus: so near, yet so far! Gastrointest Endosc 2019; 90:718-720. [PMID: 31635712 DOI: 10.1016/j.gie.2019.07.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Accepted: 07/24/2019] [Indexed: 12/11/2022]
Affiliation(s)
- Puneet Chhabra
- Department of Gastroenterology, Max Superspeciality Hospital, Patparganj, New Delhi
| | - Deepak K Bhasin
- Department of Gastroenterology and Hepatology, Fortis Hospital, Mohali, Punjab, India
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Abstract
AbstractGastric tuberculosis is very rare and is usually associated with pulmonary tuberculosis. Endoscopically, it usually resembles peptic ulcer disease or malignancy. We present a 28-year-old female who had a submucosal lesion in the body of the stomach that mimicked a submucosal tumor. Endoscopic ultrasound guided fine needle aspiration yielded caseous material, and the cytological examination confirmed the diagnosis of tuberculosis.
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Affiliation(s)
- Vishal Sharma
- Department of Gastroenterology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Surinder Singh Rana
- Department of Gastroenterology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Deepak Gunjan
- Department of Gastroenterology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Puneet Chhabra
- Department of Gastroenterology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Ravi Sharma
- Department of Gastroenterology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Deepak K. Bhasin
- Department of Gastroenterology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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Abstract
AbstractHypercalcemic states may result in acute pancreatitis. Sarcoidosis has been rarely reported as a cause of acute pancreatitis. A 42-year-old female came with abdominal pain and was found to have acute pancreatitis. Evaluation revealed hypercalcemia and evidence of pulmonary infiltrates and mediastinal lymphadenopathy. Transbronchial lung biopsy revealed noncaseating granulomas consistent with sarcoidosis. In conclusion, sarcoidosis may result in acute pancreatitis by causing hypercalcemia.
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Affiliation(s)
- Vishal Sharma
- Department of Gastroenterology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh
| | - Surinder S. Rana
- Department of Gastroenterology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh
| | - Vinita Chaudhary
- Department of Gastroenterology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh
| | - Ravi K. Sharma
- Department of Gastroenterology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh
| | - Uma Nahar
- Department of Histopathology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh
| | - Dheeraj Gupta
- Department of Pulmonary Medicine, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh
| | - Usha Dutta
- Department of Gastroenterology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh
| | - Deepak K. Bhasin
- Department of Gastroenterology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh
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Rana SS, Sharma V, Sharma R, Bhasin DK. Involvement of mediastinal/intra.abdominal lymph nodes, spleen, liver, and left adrenal in presumed isolated pancreatic tuberculosis: An endoscopic ultrasound study. Journal of Digestive Endoscopy 2019. [DOI: 10.4103/0976-5042.155236] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
AbstractBackground: Isolated pancreatic tuberculosis is very rare and closely mimics pancreatic cancer. Extra pancreatic involvement is very rare and has been rarely reported. Aim: Study the involvement of mediastinal/intra-abdominal lymph nodes, spleen, liver, and left adrenal in patients of isolated pancreatic tuberculosis using endoscopic ultrasound (EUS). Patients and Methods: Retrospective analysis of the records of 16 patients (12 males; mean age 37.8 ± 9.3 years) with pancreatic tuberculosis seen over last 4 years was done. Results: All 16 patients had a well-defined predominantly hypoechoic mass lesion in the pancreatic head and 7/16 (43%) patient had isolated pancreatic tuberculosis with no lymphadenopathy or extrapancreatic involvement. Nine (57%) patients had involvement of the peripancreatic lymph nodes and 6 (38%), 3 (19%), and 2 (13%) patients had celiac, periportal, and mediastinal nodes involvement, respectively. The diameter of the lymph nodes ranged from 1.2 cm to 2.6 cm with celiac lymph nodes being the largest. The left adrenal had normal morphology on EUS in all patients. The spleen and left lobe of the liver were also normal on EUS. Conclusions: Extra pancreatic involvement is seen in up to one-third of patients with presumed isolated pancreatic tuberculosis with involvement of peri-pancreatic and celiac lymph nodes being the commonest.
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Affiliation(s)
- Surinder S. Rana
- Department of Gastroenterology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Vishal Sharma
- Department of Gastroenterology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Ravi Sharma
- Department of Gastroenterology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Deepak K. Bhasin
- Department of Gastroenterology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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Abstract
AbstractPancreatitis, both acute and chronic, can lead on to various types of fluid collections that include pseudocysts, organized or walled off pancreatic necrosis (WOPN), and pancreatic abscess and these have been traditionally treated by surgery. The advancement in the endoscopic technology and instruments including the availability of therapeutic endoscopic ultrasound (EUS) has opened up an era of minimally invasive, safe and effective endoscopic drainage of pancreatic fluid collections (PFC). Endoscopic drainage is to be done only in symptomatic patients and it can be accomplished either through the transpapillary, transmural, or using a combination of these two routes. The decision to use one approach over the other depends on the size of the PFC, its proximity to the stomach or duodenum, presence of solid necrotic debris and the ability to enter the pancreatic duct and/or reach the area of disruption. EUS guided drainage should be considered in patients with non-bulging fluid collections, high pretest probability of bleeding, prior failed transmural entry using non-EUS guided technique and, collections inaccessible by standard technique like those located at the tail end of the pancreas.
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Affiliation(s)
- Surinder S. Rana
- Department of Gastroenterology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Deepak K. Bhasin
- Department of Gastroenterology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
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Abstract
AbstractDieulafoy’s lesion is an uncommon cause of non-variceal upper gastrointestinal (GI) bleed. They are commonly seen in stomach and are usually single. Rarely, multiple DLs may cause clinically significant GI bleed. We report a rare case of upper GI bleed due to two DL along the lesser curvature of the stomach. Hemostasis was achieved by endoscopic band ligation. Patient did not have further recurrences and was asymptomatic after 2 years.
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Affiliation(s)
- Achanta S. Chalapathi Rao
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Surinder S. Rana
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Sreekanth Appasani
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Deepak K. Bhasin
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Kartar Singh
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Rana SS, Gupta R, Kang M, Sharma V, Sharma R, Gorsi U, Bhasin DK. Percutaneous catheter drainage followed by endoscopic transluminal drainage/necrosectomy for treatment of infected pancreatic necrosis in early phase of illness. Endosc Ultrasound 2018; 7:41-47. [PMID: 29451168 PMCID: PMC5838727 DOI: 10.4103/eus.eus_94_17] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Background and Objectives: Infected pancreatic necrosis (IPN) in the early phase is treated with “step up approach” involving initial percutaneous catheter drainage (PCD) followed by necrosectomy. There is a paucity of data on a combined approach of initial PCD followed by endoscopic drainage and necrosectomy. A retrospectively study on safety and efficacy of initial PCD followed by endoscopic transluminal drainage and necrosectomy in IPN. Methods: Retrospective analysis of data of 23 patients with IPN who were treated with a combined approach. Patients were divided into two groups as follows: patients with central necrosis in whom PCD and endoscopic drainage were done in the same collection (n = 11) and patients with combined central and peripheral necrosis where PCD was placed in peripheral necrosis, and endoscopic drainage was done for central necrosis (n = 12). Results: Endoscopic drainage could be done successfully in all 23 patients with mean time for the resolution being 4.0 ± 0.9 weeks. Fifteen (65.2%) patients were successfully treated using multiple plastic stents while direct endoscopic necrosectomy (DEN) was needed in 8 (34.8%) patients and fully covered self-expanding metal stent was inserted in 6 (26%) patients. The number of endoscopic sessions needed were 3 in 3 (13%), 4 in 9 (39%) patients, 5 in 5 (22%), 6 in 3 (13%), and 7 in 3 (13%) patients, respectively. Patients of central walled-off pancreatic necrosis (WOPN) with PCD catheter in situ needed more endoscopic sessions for resolution as well as more frequently needed DEN in comparison to patients with central WOPN with no PCD catheter. Conclusion: The combined approach of initial PCD followed by endoscopic drainage and necrosectomy is safe and effective treatment alternative for patients with IPN.
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Affiliation(s)
- Surinder Singh Rana
- Department of Gastroenterology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Rajesh Gupta
- Department of Surgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Mandeep Kang
- Department of Radiodiagnosis, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Vishal Sharma
- Department of Gastroenterology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Ravi Sharma
- Department of Gastroenterology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Ujjwal Gorsi
- Department of Radiodiagnosis, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Deepak K Bhasin
- Department of Gastroenterology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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Chhabra P, Bhasin DK. Image Diagnosis: Yellow Palms and Soles: Look Beyond the Eyes and Think Beyond Hyperbilirubinemia. Perm J 2017; 21:17-034. [PMID: 29035185 DOI: 10.7812/tpp/17-034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Puneet Chhabra
- Gastroenterologist at Fortis Hospital Mohali in Punjab, India.
| | - Deepak K Bhasin
- Director of Gastroenterology and Hepatology at Fortis Hospital Mohali in Punjab, India.
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Rana SS, Sharma V, Rao C, Vaiphei K, Gupta R, Kang M, Mittal BR, Bhasin DK. Chronic diarrhea and diffuse gastric wall thickening: What is the common link? Endosc Ultrasound 2017; 6:273-275. [PMID: 28663535 PMCID: PMC5579915 DOI: 10.4103/2303-9027.199765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Affiliation(s)
- Surinder Singh Rana
- Department of Gastroenterology, Post Graduate Institute of Medical Education and Research, Sector 12, Chandigarh, India
| | - Vishal Sharma
- Department of Gastroenterology, Post Graduate Institute of Medical Education and Research, Sector 12, Chandigarh, India
| | - Chalapathi Rao
- Department of Gastroenterology, Post Graduate Institute of Medical Education and Research, Sector 12, Chandigarh, India
| | - Kim Vaiphei
- Department of Histopathology, Post Graduate Institute of Medical Education and Research, Sector 12, Chandigarh, India
| | - Rajesh Gupta
- Department of Surgery, Post Graduate Institute of Medical Education and Research, Sector 12, Chandigarh, India
| | - Mandeep Kang
- Department of Radiodiagnosis, Post Graduate Institute of Medical Education and Research, Sector 12, Chandigarh, India
| | - Bhagwant R Mittal
- Department of Nuclear Medicine, Post Graduate Institute of Medical Education and Research, Sector 12, Chandigarh, India
| | - Deepak K Bhasin
- Department of Gastroenterology, Post Graduate Institute of Medical Education and Research, Sector 12, Chandigarh, India
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Chhabra P, Brar R, Bhasin DK. An Intriguing Cause of Dysphagia. Gastroenterology 2017; 152:1839-1840. [PMID: 28478142 DOI: 10.1053/j.gastro.2017.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2016] [Accepted: 01/02/2017] [Indexed: 12/02/2022]
Affiliation(s)
- Puneet Chhabra
- Department of Gastroenterology, Hepatology and Interventional Endoscopy, Fortis Hospital, Mohali, Punjab, India
| | - Rahat Brar
- Department of Radiology, Fortis Hospital, Mohali, Punjab, India
| | - Deepak K Bhasin
- Department of Gastroenterology, Hepatology and Interventional Endoscopy, Fortis Hospital, Mohali, Punjab, India
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Chhabra P, Brar R, Bhasin DK. Unusual Case of Abdominal Pain: Finding the Missing Part. Gastroenterology 2017; 152:e9-e10. [PMID: 28478149 DOI: 10.1053/j.gastro.2016.11.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2016] [Revised: 10/05/2016] [Accepted: 11/01/2016] [Indexed: 12/02/2022]
Affiliation(s)
- Puneet Chhabra
- Department of Gastroenterology, Hepatology and Interventional Endoscopy, Punjab, India
| | - Rahat Brar
- Department of Radiology, Fortis Hospital Mohali, Punjab, India
| | - Deepak K Bhasin
- Department of Gastroenterology, Hepatology and Interventional Endoscopy, Punjab, India
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Chhabra P, Ranjan P, Bhasin DK. Simultaneous Occurrence of Varicella Zoster Virus-Induced Pancreatitis and Hepatitis in a Renal Transplant Recipient: A Case Report and Review of Literature. Perm J 2017; 21:16-083. [PMID: 28333601 DOI: 10.7812/tpp/16-083] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Gastrointestinal complications are common after renal transplantation, including oral lesions, esophagitis, gastritis, diarrhea, and colon carcinoma. The differential diagnosis is difficult in this scenario because multiple factors such as drugs, infections, and preexisting gastrointestinal disease come into play. CASE PRESENTATION We report a case of varicella zoster virus-induced pancreatitis and hepatitis in a renal transplant recipient. The patient underwent renal transplantation 3 years earlier and now presented with severe pain in the epigastrium radiating to his back and had raised serum lipase levels and skin lesions characteristic of varicella. Liver enzyme levels were also elevated. He was started on a regimen of acyclovir. His pain improved in 24 hours, and liver enzyme levels returned to normal in 48 hours. DISCUSSION There is a paucity of literature on the simultaneous occurrence of varicella zoster virus-induced hepatitis and pancreatitis in both immunocompetent and immunocompromised patients. Our case highlights the gastrointestinal complications of varicella infection in immunocompromised patients that may precede the characteristic dermatologic manifestations, and the fact that rarely both hepatitis and pancreatitis may be seen.
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Affiliation(s)
- Puneet Chhabra
- Attending Consultant in the Department of Gastroenterology and Hepatology at the Fortis Hospital Mohali in Chandigarh, Mohali, Punjab, India.
| | - Priyadarshi Ranjan
- Director of the Urology and Kidney Transplantation Department at the Fortis Hospital Mohali in Chandigarh, Mohali, Punjab, India.
| | - Deepak K Bhasin
- Director of Gastroenterology, Hepatology and Interventional Endoscopy at the Fortis Hospital Mohali in Chandigarh, Mohali, Punjab, India.
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Rana SS, Chhabra P, Sharma R, Sharma V, Gupta R, Bhasin DK. Prognostic significance of differentiating necrosis from fluid collection on endoscopic ultrasound in patients with presumed isolated extrapancreatic necrosis. Ann Gastroenterol 2017; 30:232-236. [PMID: 28243045 PMCID: PMC5320037 DOI: 10.20524/aog.2016.0106] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2016] [Accepted: 10/11/2016] [Indexed: 12/20/2022] Open
Abstract
Background Extrapancreatic necrosis is diagnosed on computed tomography (CT) as extrapancreatic changes that are more than fat stranding; both fluid collections and necrosis would have a similar appearance. The aim of this study was to determine the prognostic significance of differentiating peripancreatic necrosis from fluid collection on endoscopic ultrasound (EUS) in patients with presumed isolated extrapancreatic necrosis. Methods We carried out a retrospective analysis of prospectively collected data from 36 patients (25 males; age range 19-65 years) with acute pancreatitis (AP) and isolated extrapancreatic necrosis. On EUS, peripancreatic anechoic areas were labeled as peripancreatic fluid collections and peripancreatic heterogeneously echotextured areas as peripancreatic necrosis. Results The etiology of AP was alcohol in 16 (44.4%) patients, gallstone disease in 13 (36.1%), and other in 7 (19.4%). On EUS, 25 (69.4%) patients had peripancreatic necrosis and 11 (30.6%) patients had peripancreatic fluid collections. Compared with patients who had peripancreatic fluid collections, patients with peripancreatic necrosis had a significantly higher frequency of pleural effusion (88% vs. 55%; P=0.04), organ failure (OF) (68% vs. 27%; P=0.03), and persistent OF (48% vs. 9%; P=0.03). The patients with peripancreatic necrosis also had a higher frequency of ascites (20% vs. 9%), need for intervention (20% vs. nil), surgery (8% vs. nil) and mortality (8% vs. nil), but these differences were not statistically significant. Conclusion Isolated extrapancreatic necrosis on contrast-enhanced CT comprises a heterogeneous group, with patients who show peripancreatic fluid collections on EUS having a less severe disease course compared to patients with peripancreatic necrosis.
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Affiliation(s)
- Surinder S Rana
- Department of Gastroenterology (Surinder S. Rana, Puneet Chhabra, Ravi Sharma, Vishal Sharma, Deepak K. Bhasin)
| | - Puneet Chhabra
- Department of Gastroenterology (Surinder S. Rana, Puneet Chhabra, Ravi Sharma, Vishal Sharma, Deepak K. Bhasin); Current affiliation: Fortis Hospital, Mohali, India
| | - Ravi Sharma
- Department of Gastroenterology (Surinder S. Rana, Puneet Chhabra, Ravi Sharma, Vishal Sharma, Deepak K. Bhasin)
| | - Vishal Sharma
- Department of Gastroenterology (Surinder S. Rana, Puneet Chhabra, Ravi Sharma, Vishal Sharma, Deepak K. Bhasin)
| | - Rajesh Gupta
- Department of Surgery (Rajesh Gupta), Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Deepak K Bhasin
- Department of Gastroenterology (Surinder S. Rana, Puneet Chhabra, Ravi Sharma, Vishal Sharma, Deepak K. Bhasin); Current affiliation: Fortis Hospital, Mohali, India
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Rana SS, Sharma V, Sharma R, Gupta R, Bhasin DK. Endoscopic ultrasound guided transmural drainage of walled off pancreatic necrosis using a "step - up" approach: A single centre experience. Pancreatology 2017; 17:203-208. [PMID: 28202234 DOI: 10.1016/j.pan.2017.02.007] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2016] [Revised: 02/06/2017] [Accepted: 02/07/2017] [Indexed: 12/11/2022]
Abstract
BACKGROUND Walled off necrosis (WON) can be treated endoscopically using multiple transmural plastic stents or fully covered self-expandable metallic stent (FCSEMS) and direct endoscopic necrosectomy (DEN). We evaluated the efficacy of "step-up" endoscopic transmural approach for treatment of WON. METHODS Retrospective analysis of data of 86 patients with WON who were treated with attempted endoscopic ultrasound (EUS) guided "step up" transmural drainage during last 5 years was done. Initially multiple plastic stents were placed and patients not responding underwent FCSEMS placement and/or DEN. RESULTS Patients presented 10.8 ± 2.8 weeks after an acute attack of acute pancreatitis and mean size of WON was 10.7 ± 2.9 cm. EUS guided transmural drainage was technically successful in 85/86 (98.8%) patients and 70 (82.4%) were drained with multiple 7/10Fr plastic stents alone while DEN was needed in 9 (10.6%) and FCSEMS was inserted in 6 (7%) patients. All patients had successful outcome with none requiring surgery. The patients who needed DEN/FCSEMS presented earlier and had large size collection with more solid necrotic debris as compared to patients treated with multiple plastic stents alone. The complications were pneumoperitoneum (n = 1), bile leak following cholecystecomy (n = 1), development of external pancreatic fistula following percutaneous drainage (n = 1) and gastrointestinal bleed (n = 1). CONCLUSIONS "Step up" endoscopic transmural drainage using multiple plastic stents as an initial therapy is safe and effective treatment of WON and avoids more aggressive DEN in majority of patients. Large size WON with more necrotic debris may require DEN.
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Affiliation(s)
- Surinder S Rana
- Department of Gastroenterology, Post Graduate Institute of Medical Education and Research (PGIMER), Sector 12, Chandigarh 160012, India.
| | - Vishal Sharma
- Department of Gastroenterology, Post Graduate Institute of Medical Education and Research (PGIMER), Sector 12, Chandigarh 160012, India
| | - Ravi Sharma
- Department of Gastroenterology, Post Graduate Institute of Medical Education and Research (PGIMER), Sector 12, Chandigarh 160012, India
| | - Rajesh Gupta
- Department of Surgery, Post Graduate Institute of Medical Education and Research (PGIMER), Sector 12, Chandigarh 160012, India
| | - Deepak K Bhasin
- Department of Gastroenterology, Post Graduate Institute of Medical Education and Research (PGIMER), Sector 12, Chandigarh 160012, India
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Chhabra P, Bhasin DK. Negative result of capsule endoscopy in obscure GI bleeding: searching in the dark despite bright lights. Gastrointest Endosc 2017; 85:318-321. [PMID: 28089030 DOI: 10.1016/j.gie.2016.10.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2016] [Accepted: 10/09/2016] [Indexed: 01/08/2023]
Affiliation(s)
- Puneet Chhabra
- Department of Gastroenterology and Hepatology, Fortis Hospital, Mohali, Punjab, India
| | - Deepak K Bhasin
- Department of Gastroenterology and Hepatology, Fortis Hospital, Mohali, Punjab, India
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16
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Rana SS, Sharma R, Sharma V, Dhalaria L, Gupta R, Basher RK, Mittal BR, Das A, Bhasin DK. Hepatobiliary and Pancreatic: Unusual space occupying lesion of liver. J Gastroenterol Hepatol 2016; 31:1916. [PMID: 27898995 DOI: 10.1111/jgh.13509] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/30/2016] [Indexed: 12/09/2022]
Affiliation(s)
- Surinder Singh Rana
- Department of Gastroenterology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Ravi Sharma
- Department of Gastroenterology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Vishal Sharma
- Department of Gastroenterology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Lovneet Dhalaria
- Department of Gastroenterology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Rajesh Gupta
- Department of Surgery, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Rajender K Basher
- Department of Nuclear Medicine, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Bhagwant R Mittal
- Department of Nuclear Medicine, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Ashim Das
- Department of Histopathology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Deepak K Bhasin
- Department of Gastroenterology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
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Chhabra P, Ranjan P, Aggarwal N, Gupta V, Mahajan V, Bhasin DK. Primary varicella zoster virus infection in renal transplant recipients. Indian Journal of Transplantation 2016. [DOI: 10.1016/j.ijt.2016.09.082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Abstract
Purpose: To evaluate the various radiological abnormalities in patients with proven esophageal tuberculosis. Material and Methods: The case records of 23 patients with proven esophageal tuberculosis were evaluated retrospectively for various radiological abnormalities. Twenty-two patients had secondary involvement of esophagus in the form of direct extension of mediastinal and pulmonary tuberculosis or spinal tuberculosis. Only 1 patient had primary involvement of the esophagus with no evidence of disease elsewhere. The diagnosis was confirmed by endoscopic and CT-guided biopsy/aspiration cytology in 7 and 6 cases, respectively. Diagnosis was made on the basis of surgical biopsy of lymph node and autopsy in 1 patient each. In the remaining 8 patients the diagnosis was based on radiological and endoscopic findings and the response to antituberculous treatment. Results: Chest radiography (CXR) was abnormal in 65% patients. While the findings were non-conclusive for esophageal tuberculosis, characteristic lesions of tuberculosis in lungs or spine were suggestive of tuberculous etiology. In 15 patients, CT of the chest confirmed the corresponding CXR findings and also showed additional findings of mediastinal lymphadenopathy when CXR was normal. Fourteen patients showed mediastinal lymphadenopathy on CT of the chest. In all these patients, more than one group of lymph nodes was involved. The characteristic hypodense center of lymph nodes suggestive of tuberculosis was seen in 12 patients. Radiological abnormalities seen in barium swallow examination were extrinsic compression, traction diverticula, strictures, sinus/fistulous tracts, kinking and pseudotumor mass of esophagus in decreasing order of frequency. The middle third of the esophagus was found to be the most frequent site of involvement.
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Affiliation(s)
- B Nagi
- Department of Gastroenterology, PGIMER, Chandigarh, India
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Sharma V, Rana SS, Bhasin DK. Extra-pancreatic necrosis alone: Contours of an emerging entity. J Gastroenterol Hepatol 2016; 31:1414-21. [PMID: 27010174 DOI: 10.1111/jgh.13384] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2016] [Revised: 03/06/2016] [Accepted: 03/15/2016] [Indexed: 12/19/2022]
Abstract
Acute pancreatitis is of two morphologic types: interstitial edematous pancreatitis that is not associated with any tissue necrosis and necrotizing pancreatitis wherein the pancreatic parenchyma with or without varying amount of extra-pancreatic tissue/fat undergoes necrosis. Necrotizing pancreatitis has a worse outcome compared with interstitial pancreatitis because of increased severity related to a heightened systemic response and cytokine storm associated with tissue necrosis. Increasingly, an entity of extra-pancreatic necrosis (EPN) alone, wherein the pancreatic parenchyma is normal on an enhanced computed tomographic scan but the peri-pancreatic tissues undergo necrosis, is being recognized. Available data suggest that the outcomes in patients with EPN alone are between the excellent prognosis of patients with interstitial and adverse prognosis of patients with necrotizing pancreatitis. The extent of EPN also seems to determine the outcome. This review summarizes the currently available literature on this entity and various radiological scores that have been suggested to determine the presence and stage of EPN.
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Affiliation(s)
- Vishal Sharma
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Surinder S Rana
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Deepak K Bhasin
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
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Rana SS, Dambalkar A, Chhabra P, Sharma R, Nada R, Sharma V, Rana S, Bhasin DK. Is pancreatic exocrine insufficiency in celiac disease related to structural alterations in pancreatic parenchyma? Ann Gastroenterol 2016; 29:363-6. [PMID: 27366039 PMCID: PMC4923824 DOI: 10.20524/aog.2016.0042] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2016] [Accepted: 04/20/2016] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Although exocrine pancreatic insufficiency (EPI) has been reported in a number of patients with celiac disease (CD), it is not clear if this is primarily a functional or a structural defect. We studied pancreatic structural abnormalities by endoscopic ultrasound (EUS) in adult CD patients with EPI. METHODS Pancreatic exocrine function was prospectively assessed in 36 recently diagnosed CD patients (mean age: 29.8 years) by measuring fecal elastase. Pancreatic structural changes were assessed in CD patients with EPI by EUS and elastography. Exocrine functions were reassessed after 3 months of gluten-free diet. RESULTS Of the 36 CD patients included, 30 (83%) had anemia, 21 (58%) diarrhea, and 7 (19%) hypothyroidism. Ten (28%) patients had EPI with mean elastase levels of 141.6 μg/g of stool, of whom only one had a history of recurrent acute pancreatitis while the rest 9 patients had no history of acute or chronic pancreatitis. Of these 10 patients, 8 (80%) had diarrhea, 8 (80%) anemia, and 2 (20%) hypothyroidism. EUS was done in 8 patients which showed: normal pancreas in 5 (50%), hyperechoic strands in 3 (30%), and hyperechoic foci without shadowing in 2 (20%) patients. None had lobularity or parenchymal calcification. All patients except the patient with recurrent pancreatitis had normal strain ratio. Follow-up fecal elastase was within normal range in 6 of 7 (86%) patients. CONCLUSION EPI, assessed by fecal elastase levels in adult CD patients, possibly does not relate to structural alterations in the pancreatic parenchyma and may be reversible by following a gluten-free diet.
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Affiliation(s)
- Surinder S Rana
- Department of Gastroenterology (Surinder S. Rana, Arvind Dambalkar, Puneet Chhabra, Ravi Sharma, Vishal Sharma, Satyavati Rana, Deepak K. Bhasin), Chandigarh, India
| | - Arvind Dambalkar
- Department of Gastroenterology (Surinder S. Rana, Arvind Dambalkar, Puneet Chhabra, Ravi Sharma, Vishal Sharma, Satyavati Rana, Deepak K. Bhasin), Chandigarh, India
| | - Puneet Chhabra
- Department of Gastroenterology (Surinder S. Rana, Arvind Dambalkar, Puneet Chhabra, Ravi Sharma, Vishal Sharma, Satyavati Rana, Deepak K. Bhasin), Chandigarh, India
| | - Ravi Sharma
- Department of Gastroenterology (Surinder S. Rana, Arvind Dambalkar, Puneet Chhabra, Ravi Sharma, Vishal Sharma, Satyavati Rana, Deepak K. Bhasin), Chandigarh, India
| | - Ritambhra Nada
- Department of Histopathology (Ritambhra Nada), Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Vishal Sharma
- Department of Gastroenterology (Surinder S. Rana, Arvind Dambalkar, Puneet Chhabra, Ravi Sharma, Vishal Sharma, Satyavati Rana, Deepak K. Bhasin), Chandigarh, India
| | - Satyavati Rana
- Department of Gastroenterology (Surinder S. Rana, Arvind Dambalkar, Puneet Chhabra, Ravi Sharma, Vishal Sharma, Satyavati Rana, Deepak K. Bhasin), Chandigarh, India
| | - Deepak K Bhasin
- Department of Gastroenterology (Surinder S. Rana, Arvind Dambalkar, Puneet Chhabra, Ravi Sharma, Vishal Sharma, Satyavati Rana, Deepak K. Bhasin), Chandigarh, India
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Rana SS, Gunjan D, Bhasin DK. Pneumoperitoneum due to a necrotic cavity wall perforation seen at endoscopic necrosectomy. Endoscopy 2016; 47 Suppl 1 UCTN:E391-2. [PMID: 26273776 DOI: 10.1055/s-0034-1392506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Affiliation(s)
- Surinder S Rana
- Department of Gastroenterology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Deepak Gunjan
- Department of Gastroenterology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Deepak K Bhasin
- Department of Gastroenterology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
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Abstract
Background Hypocalcemia is a marker of poor prognosis in acute pancreatitis (AP) but the prognostic significance of hypocalcemic tetany in patients with AP has not been studied. We aimed to determine the prognostic significance of hypocalcemic tetany in patients with AP. Methods Consecutive patients of AP who presented within 7 days of symptoms were included. Serum calcium levels were measured on admission and the patients were divided into two groups based on the presence (group 1) or absence of hypocalcemia (group 2). Chvostek and Trousseau signs were sought in all patients with hypocalcemia and the outcome measures were compared between patients with normocalcemia, asymptomatic and symptomatic hypocalcemia (tetany). The outcome parameters assessed were persistent organ failure (POF), need for intervention, and mortality. Results Of 105 patients (53 male; mean age 37.34±12.62 years), 37 (35.2%) had hypocalcemia (group 1) and 68 (64.8%) had normal corrected serum calcium levels (group 2). Patients with hypocalcemia had significantly higher frequency of POF, mortality and need for intervention (P<0.05). Twelve of 37 (32.4%) patients with hypocalcemia had tetany. Patients with tetany had significantly lower serum corrected calcium and ionized calcium levels compared with patients with asymptomatic hypocalcemia (P<0.05). Patients with tetany had significantly higher mortality rates compared with patients with asymptomatic hypocalcemia (100% vs. 8%; P=0.00001) as well as POF (100% vs. 32%; P=0.000006). Conclusion Presence of hypocalcemic tetany in AP patients bears a poor prognosis and is associated with increased mortality.
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Affiliation(s)
- Puneet Chhabra
- Department of Gastroenterology, Fortis Hospital, Mohali, Punjab (Puneet Chhabra, Deepak K. Bhasin), India
| | - Surinder S Rana
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh (Surinder S. Rana, Vishal Sharma, Ravi Sharma), India
| | - Vishal Sharma
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh (Surinder S. Rana, Vishal Sharma, Ravi Sharma), India
| | - Ravi Sharma
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh (Surinder S. Rana, Vishal Sharma, Ravi Sharma), India
| | - Deepak K Bhasin
- Department of Gastroenterology, Fortis Hospital, Mohali, Punjab (Puneet Chhabra, Deepak K. Bhasin), India
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Gunjan D, Rana SS, Gupta R, Bhasin DK. Tracheo-esophageal fistula following spontaneous migration of a missed impacted denture. Endoscopy 2016; 47 Suppl 1 UCTN:E331-2. [PMID: 26115401 DOI: 10.1055/s-0034-1392326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Affiliation(s)
- Deepak Gunjan
- Department of Gastroenterology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Surinder S Rana
- Department of Gastroenterology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Rajesh Gupta
- Department of Surgery, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Deepak K Bhasin
- Department of Gastroenterology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
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Abstract
Pancreatic tuberculosis is very rare, but recently, there has been a spurt in the number of reports on pancreatic involvement by tuberculosis. It closely mimics pancreatic cancer, and before the advent of better imaging modalities it was often detected as a histological surprise in patients resected for a presumed pancreatic malignancy. The usual presentation involves abdominal pain, loss of appetite and weight, jaundice which can be associated with cholestasis, fever and night sweats, palpable abdominal lump, and peripheral lymphadenopathy. Computed tomography (CT) of the abdomen is an important tool for evaluation of patients with pancreatic tuberculosis. This CT imaging yields valuable information about the size and nature of tubercular lesions along with the presence of ascites and lymphadenopathy. However, there are no distinctive features on CT that distinguish it from pancreatic carcinoma. Endoscopic ultrasound provides high resolution images of the pancreatic lesions as well as an opportunity to sample these lesions for cytological confirmation. The presence of granulomas is the most common finding on histological/cytological examination with the presence of acid fast bacilli being observed only in minority of patients. As there are no randomized or comparative studies on treatment of pancreatic tuberculosis it is usually treated like other forms of tuberculosis. Excellent cure rates are reported with standard anti tubercular therapy given for 6-12 months.
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Affiliation(s)
- Vishal Sharma
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Surinder S Rana
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Amit Kumar
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Deepak K Bhasin
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Rana SS, Sharma V, Bhasin DK, Sharma R, Gupta R, Chhabra P, Kang M. Gastrointestinal bleeding in acute pancreatitis: etiology, clinical features, risk factors and outcome. ACTA ACUST UNITED AC 2016; 36:31-5. [PMID: 26591952 DOI: 10.7869/tg.242] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND There is paucity of data on the effect of interventions on risk of gastrointestinal bleeding (GIB) in acute pancreatitis (AP). METHODS Retrospective study of records of patients with AP and GIB. RESULTS 16 (3.7%) patients (14 males; mean age 39.3 ± 12.8 years) had gastrointestinal bleeding. Two patients had peptic ulcer disease related GIB. The cause of GIB in remaining patients was: pseudoaneurysms in 5, gastrointestinal fistulization in 4, and no identifiable lesion in 5. Two patients with pseudoaneurysms were treated with angioembolisation whereas 3 needed surgery. The patients with gastrointestinal fistula had complicated course and 3 of these 4 patients died due to sepsis and multi organ failure. Rest 5 patients with no identifiable lesion were managed conservatively and there was no recurrence of GIB. Of the 14 patients with AP related GIB, a previous intervention had been done in 11(79%) patients. Fifty-three patients (12.7%) without GIB died whereas 5 (31.2%) patients with GIB succumbed to the illness (p = 0.04). CONCLUSIONS The majority of our patients of AP with GIB had antecedent history of interventions. The mortality was higher in patients with GIB, which was not due to hemorrhage but to sepsis and related complications.
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Sharma V, Rana SS, Sharma R, Chaudhary V, Gupta R, Bhasin DK. Naso-jejunal fluid resuscitation in predicted severe acute pancreatitis: Randomized comparative study with intravenous Ringer's lactate. J Gastroenterol Hepatol 2016. [PMID: 26201934 DOI: 10.1111/jgh.13047] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
INTRODUCTION Early management of severe acute pancreatitis (SAP) includes intravenous fluid resuscitation. AIM To confirm feasibility of naso-jejunal (NJ) fluid resuscitation using oral hydration solution (ORS) and compare its efficacy with intravenous (IV) fluid resuscitation using Ringer Lactate (RL) in predicted SAP. PATIENTS AND METHODS All patients of predicted SAP (presence of SIRS or BISAP > 2) without significant co morbidities were randomized to NJ group (ORS: 20 ml/kg bolus and then 3 mL/kg/h) or IV group (RL infusion at same rate). The groups were compared vis-à-vis persistent organ failure (POF), pancreatic necrosis, and mortality. RESULTS Seventy-seven patients were assessed and after exclusion, 49 patients were randomized to either NJ (24 patients) or IV group (25). The demographic and baseline clinical profile of both groups including BISAP score (2.25 ± 0.73 and 2.32 ± 0.56), hematocrit (40.2 ± 6.8 and 38.3 ± 6.6), blood urea nitrogen (16.88 ± 6.69 and 21.44 ± 17.56 mg/dL), and intra-abdominal pressure (14.55 ± 4.8 and 14.76 ± 5.5 cm of water) were similar. NJ resuscitation had to be stopped in two patients because of abdominal discomfort and distension. The change in intra abdominal pressure after 48 h of hydration was comparable in both groups. The occurrence of POF (66.67% and 68%), pancreatic necrosis (69.5% and 76%), intervention (5 each), surgery (1 each), and mortality (16.5% and 8%) were comparable (P > 0.05). CONCLUSION In select group of patients with SAP, NJ fluid resuscitation with ORS is feasible and is equally efficacious as IV fluid resuscitation with RL.
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Affiliation(s)
- Vishal Sharma
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, India
| | - Surinder S Rana
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, India
| | - Ravi Sharma
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, India
| | - Vinita Chaudhary
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, India
| | - Rajesh Gupta
- Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Deepak K Bhasin
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, India
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Gunjan D, Rana SS, Chhabra P, Parghane RV, Kumar R, Dhalaria L, Mittal BR, Bhasin DK. Primary squamous cell carcinoma of pancreas mimicking walled-off pancreatic necrosis. Journal of Digestive Endoscopy 2016. [DOI: 10.4103/0976-5042.180094] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
AbstractPancreatic carcinoma is a dreaded diagnosis due to its poor prognosis. Squamous cell carcinoma (SCC) of the pancreas is a rare histological variety of pancreatic carcinoma. Its diagnosis is based on ruling out other site of tumor origin. Pancreatic carcinoma can mimic as mass or cystic lesion. We report a case of primary SCC of the pancreas in a 46-year-old male that closely mimicked acute pancreatitis with walled-off pancreatic necrosis.
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Affiliation(s)
- Deepak Gunjan
- Departments of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Surinder Singh Rana
- Departments of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Puneet Chhabra
- Departments of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Rahul Vithalrao Parghane
- Department of Gastroenterology, Nuclear Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Rajesh Kumar
- Department of Gastroenterology, Cytology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Lovneet Dhalaria
- Departments of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Bhawant R. Mittal
- Department of Gastroenterology, Nuclear Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Deepak K. Bhasin
- Departments of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Rana SS, Sharma R, Bhasin DK. Endoscopic detection of a potentially dangerous large vessel coursing through a walled-off pancreatic necrosis. Ann Gastroenterol 2016; 29:93. [PMID: 26751796 PMCID: PMC4700855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Affiliation(s)
- Surinder S. Rana
- Department of Gastroenterology, Post Graduate Institute of Medical Education and Research, India,
Correspondence to: Dr Surinder Singh Rana, Ass. Professor, Department of Gastroenterology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012 India, Tel.: +91 172 2749123, Fax: +91 172 2744401, e-mail: ,
| | - Ravi Sharma
- Department of Gastroenterology, Post Graduate Institute of Medical Education and Research, India
| | - Deepak K. Bhasin
- Department of Gastroenterology, Post Graduate Institute of Medical Education and Research, India
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Affiliation(s)
- Ritambhra Nada
- Department of Histopathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Surinder Singh Rana
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Ravi Sharma
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Lovneet Dhalaria
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Harpreet Singh
- Department of Nuclear Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Bhagwant R Mittal
- Department of Nuclear Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Rajesh Gupta
- Department of Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Deepak K Bhasin
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Rana SS, Sharma V, Sharma R, Gunjan D, Dhalaria L, Gupta R, Bhasin DK. Gastric gastrointestinal stromal tumor mimicking cystic tumor of the pancreas: Diagnosed by endoscopic ultrasound-fine-needle aspiration. Endosc Ultrasound 2015; 4:351-2. [PMID: 26643707 PMCID: PMC4672597 DOI: 10.4103/2303-9027.170452] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Affiliation(s)
- Surinder S Rana
- Department of Gastroenterology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
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Rana SS, Sharma V, Bhasin DK. External pancreatic fistula with disconnected pancreatic duct treated by transmural stent insertion through the transgastric percutaneous catheter site. Gastrointest Endosc 2015; 82:1130-1; discussion 1131-2. [PMID: 26168703 DOI: 10.1016/j.gie.2015.06.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2015] [Accepted: 06/04/2015] [Indexed: 02/08/2023]
Affiliation(s)
- Surinder S Rana
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Vishal Sharma
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Deepak K Bhasin
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Affiliation(s)
- Vishal Sharma
- Department of Gastroenterology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Surinder S Rana
- Department of Gastroenterology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Deepak K Bhasin
- Department of Gastroenterology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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Sharma V, Rana SS, Bhasin DK. Endoscopic ultrasound guided interventional procedures. World J Gastrointest Endosc 2015; 7:628-42. [PMID: 26078831 PMCID: PMC4461937 DOI: 10.4253/wjge.v7.i6.628] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2014] [Revised: 01/24/2015] [Accepted: 02/09/2015] [Indexed: 02/05/2023] Open
Abstract
Endoscopic ultrasound (EUS) has emerged as an important diagnostic and therapeutic modality in the field of gastrointestinal endoscopy. EUS provides access to many organs and lesions which are in proximity to the gastrointestinal tract and thus giving an opportunity to target them for therapeutic and diagnostic purposes. This modality also provides a real time opportunity to target the required area while avoiding adjacent vascular and other structures. Therapeutic EUS has found role in management of pancreatic fluid collections, biliary and pancreatic duct drainage in cases of failed endoscopic retrograde cholangiopancreatography, drainage of gallbladder, celiac plexus neurolysis/blockage, drainage of mediastinal and intra-abdominal abscesses and collections and in targeted cancer chemotherapy and radiotherapy. Infact, therapeutic EUS has emerged as the therapy of choice for management of pancreatic pseudocysts and recent innovations like fully covered removable metallic stents have improved results in patients with organised necrosis. Similarly, EUS guided drainage of biliary tract and pancreatic duct helps drainage of these systems in patients with failed cannulation, inaccessible papilla as with duodenal/gastric obstruction or surgically altered anatomy. EUS guided gall bladder drainage is a useful emergent procedure in patients with acute cholecystitis who are not fit for surgery. EUS guided celiac plexus neurolysis and blockage is more effective and less morbid vis-à-vis the percutaneous technique. The field of interventional EUS is rapidly advancing and many more interventions are being continuously added. This review focuses on the current status of evidence vis-à-vis the established indications of therapeutic EUS.
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Affiliation(s)
- Surinder S Rana
- Department of Gastroenterology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Vishal Sharma
- Department of Gastroenterology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Deepak K Bhasin
- Department of Gastroenterology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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Affiliation(s)
- Surinder S Rana
- Department of Gastroenterology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Deepak K Bhasin
- Department of Gastroenterology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
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Sharma V, Rana SS, Chhabra P, Reddy YR, Bhasin DK. Catastrophic complication of ingestion of corrosive substance. Endoscopy 2015; 46 Suppl 1 UCTN:E299-300. [PMID: 25058821 DOI: 10.1055/s-0034-1365821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Affiliation(s)
- Vishal Sharma
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Surinder S Rana
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Puneet Chhabra
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Yalaka R Reddy
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Deepak K Bhasin
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
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Rana SS, Sharma V, Sharma RK, Chhabra P, Gupta R, Bhasin DK. Clinical significance of presence and extent of extrapancreatic necrosis in acute pancreatitis. J Gastroenterol Hepatol 2015; 30:794-8. [PMID: 25251298 DOI: 10.1111/jgh.12793] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/12/2014] [Indexed: 01/29/2023]
Abstract
BACKGROUND AND AIM Extrapancreatic necrosis (EPN) alone represents a subgroup of pancreatitis with better outcome than patients with pancreatic parenchymal necrosis (PN). However, data on clinical significance of EPN is limited, and significance of the extent of EPN is not known. METHODS Two hundred thirteen patients (136 [63.8%] males; mean age: 39.8 ± 13.2 years) with acute pancreatitis were prospectively enrolled and followed up till recovery or death. Contrast-enhanced computed tomography of each patient was retrospectively evaluated for presence of PN and EPN, pleural effusion and ascites. EPN was termed extensive if it extended to paracolic gutters or pelvis. RESULTS Twenty-one (9.9%) patients had interstitial pancreatitis, seven (3.3%) patients had PN alone, 48 (22.5%) patients had EPN alone, and 137 (64.3%) patients had combined PN and EPN. Patients with EPN alone had significantly higher frequency of organ failure than patients with interstitial pancreatitis. Compared with patients with EPN alone, the patients with combined necrosis had significantly higher frequency of pleural effusion (88.2% vs. 75%), ascites (41% vs. 20.8%), and need for intervention (32.6% vs. 14.6%). Patients with extensive EPN (n = 57) had significantly higher frequency of pleural effusion, ascites, and multi-organ failure than those with limited EPN. CONCLUSION EPN alone should be considered as a separate category of acute pancreatitis as it has less severe course than PN but has more severe course than interstitial pancreatitis. Patients with extensive EPN in spite of having increased frequency of ascites, pleural effusion, and multi-organ failure had similar outcome as compared to patients with limited EPN.
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Affiliation(s)
- Surinder S Rana
- Department of Gastroenterology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
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Sharma V, Prasada KVR, Kancharla H, Sharma R, Rana SS, Bhasin DK. Pancreatic pleural effusion due to ductal disruption upstream of a tight ductal stricture in patient with chronic calcific pancreatitis: Successful management with pancreatic sphincterotomy and dilatation of ductal stricture by Guide Wire. Journal of Digestive Endoscopy 2015. [DOI: 10.4103/0976-5042.159239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
AbstractEndoscopic therapy has evolved as the standard of care for pancreatic pleural effusion and pancreatic ascites. Endoscopic retrograde cholangiopancreatography and bridging the disruption of ductal disruption with stent placement is the treatment of choice. However, it may not be always possible to negotiate tight pancreatic duct (PD) strictures or stricture stone complex, and endoscopic sphincterotomy alone may not be sufficient. We report a 53-year-old male who had chronic calcific pancreatitis with bilateral pancreatic pleural effusion and a tight stricture at head body junction, across which conventional endoscopic accessories could not be negotiated except for the 0.035 inch guidewire, which we kept across the stricture for 48 h for guidewire induced stricture dilation. This led to the complete resolution of symptoms and pancreatic pleural effusion. Combination of endoscopic sphincterotomy and guide wire induced stricture dilation can be used as rescue technique in cases of very tight PD strictures with complications such as pancreatic pleural effusion.
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Affiliation(s)
- Vishal Sharma
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Sector 12, Chandigarh
| | - K. V. Raghavendra Prasada
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Sector 12, Chandigarh
| | - Harish Kancharla
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Sector 12, Chandigarh
| | - Ravi Sharma
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Sector 12, Chandigarh
| | - Surinder S. Rana
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Sector 12, Chandigarh
| | - Deepak K. Bhasin
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Sector 12, Chandigarh
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Prabhakar N, Kalra N, Bhasin DK, Rana SS, Gupta V, Singh R, Khandelwal N. Comparison of CT colonography with conventional colonoscopy in patients with ulcerative colitis. Acad Radiol 2015; 22:296-302. [PMID: 25435187 DOI: 10.1016/j.acra.2014.09.016] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2014] [Revised: 09/21/2014] [Accepted: 09/26/2014] [Indexed: 02/01/2023]
Abstract
RATIONALE AND OBJECTIVE Patients with ulcerative colitis require recurrent conventional colonoscopy (CC) to define the extent of the disease. Computed tomography (CT) colonography (CTC) can be used as an alternative technique for studying the colon in these patients. The purpose of the study was to compare the findings of CTC to CC in patients with ulcerative colitis. MATERIALS AND METHODS Twenty patients proven to have ulcerative colitis on biopsy and in clinical remission state were enrolled in the study. They underwent CTC and CC within 1 week of each test. The investigators performing CTC and CC were blinded to the findings of each other. The chi-square test, kappa test, sensitivity, and specificity were used to compare the findings on CTC and CC. In addition, patient acceptance for both the procedures was compared. RESULTS Sensitivity and specificity on CTC for detecting granular appearance were 81.0% and 73.8%, respectively, and for pseudopolyps were 82.1% and 84.5%, respectively. Good correlation was seen between CTC and CC for detection of granular appearance and pseudopolyps. Loss of haustral folds, wall thickening, pericolonic vascularity, and pericolonic lymph nodes seen on CTC were found to correlate with intraluminal findings seen on CC. Patient acceptance for CTC was better than that for CC. CONCLUSIONS CTC can be used for evaluating patients with ulcerative colitis who are in remission.
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Affiliation(s)
- Nidhi Prabhakar
- Department of Radiodiagnosis, PGIMER, Chandigarh 160012, India
| | - Naveen Kalra
- Department of Radiodiagnosis, PGIMER, Chandigarh 160012, India.
| | | | | | - Vikas Gupta
- Department of General Surgery, PGIMER, Chandigarh, India
| | - Rajinder Singh
- Department of General Surgery, PGIMER, Chandigarh, India
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Rana SS, Chaudhary V, Sharma R, Sharma V, Chhabra P, Bhasin DK. Comparison of abdominal ultrasound, endoscopic ultrasound and magnetic resonance imaging in detection of necrotic debris in walled-off pancreatic necrosis. Gastroenterol Rep (Oxf) 2015; 4:50-3. [PMID: 25573950 PMCID: PMC4760061 DOI: 10.1093/gastro/gou088] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2014] [Accepted: 12/08/2014] [Indexed: 12/13/2022] Open
Abstract
Background: Walled-off pancreatic necrosis (WOPN) is an important complication of acute pancreatitis that is diagnosed by imaging modalities such as endoscopic ultrasound (EUS) or magnetic resonance imaging (MRI), which can clearly visualize necrotic debris. The effectiveness of abdominal ultrasound (USG) in detecting solid debris in WOPN is not clear. Methods: A total of 52 patients (37 males, mean age 38.9 ± 12.6 years) with symptomatic WOPN were prospectively studied using EUS, MRI and USG. These investigations were done at a mean of 11.7 ± 5.5 weeks of onset of acute pancreatitis and within two days. Results: WOPN was detected by EUS & MRI in all patients, whereas USG could not detect it in 4 (7.6%) patients (3 had predominantly solid WOPN, whereas one had air foci in WOPN). USG, MRI and EUS could detect solid debris in all patients with detectable WOPN. EUS and USG detected <10% debris in 10 (20%) patients, whereas MRI detected <10% debris in 14 (27%) patients. EUS and USG detected 10–40% debris in 33 patients whereas MRI detected 10–40% debris in 30 (58%) patients. More than 40% debris was better characterized on EUS and MRI with both detecting >40% debris in 8 patients (15%) compared to 5 (11%) patients having >40% debris on USG. EUS detected collaterals around WOPN that were not detected on USG or MRI. Conclusion: USG can characterize the majority of WOPN, with accuracy comparable to that of EUS/MRI. However its limitations are the inability to detect collaterals around WOPN and characterize collections with high solid content or air.
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Affiliation(s)
- Surinder S Rana
- Department of Gastroenterology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Vinita Chaudhary
- Department of Gastroenterology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Ravi Sharma
- Department of Gastroenterology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Vishal Sharma
- Department of Gastroenterology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Puneet Chhabra
- Department of Gastroenterology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Deepak K Bhasin
- Department of Gastroenterology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
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Sharma V, Rana SS, Dhaka N, Saikia UN, Hemanth KK, Gupta R, Bhasin DK. Small bowel tuberculosis causing massive obscure gastrointestinal bleeding in an immunocompromised patient. Ann Gastroenterol 2015; 28:496. [PMID: 26424143 PMCID: PMC4585399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Affiliation(s)
- Vishal Sharma
- Department of Gastroenterology (Vishal Sharma, Surinder S. Rana, Narendra Dhaka, Deepak K. Bhasin), Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Surinder S. Rana
- Department of Gastroenterology (Vishal Sharma, Surinder S. Rana, Narendra Dhaka, Deepak K. Bhasin), Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India,
Correspondence to: Dr Surinder Singh Rana, Ass. Professor, Department of Gastroenterology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012 India, Tel.: +91 172 2749123, Fax: +91 172 2744401, e-mail: ,
| | - Narendra Dhaka
- Department of Gastroenterology (Vishal Sharma, Surinder S. Rana, Narendra Dhaka, Deepak K. Bhasin), Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Uma Nahar Saikia
- Department of Histopathology (Uma Nahar Saikia), Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Kumar K. Hemanth
- Department of Surgery (Kumar K. Hemanth, Rajesh Gupta), Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Rajesh Gupta
- Department of Surgery (Kumar K. Hemanth, Rajesh Gupta), Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Deepak K. Bhasin
- Department of Gastroenterology (Vishal Sharma, Surinder S. Rana, Narendra Dhaka, Deepak K. Bhasin), Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
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Ramakrishna BS, Makharia GK, Ahuja V, Ghoshal UC, Jayanthi V, Perakath B, Abraham P, Bhasin DK, Bhatia SJ, Choudhuri G, Dadhich S, Desai D, Goswami BD, Issar SK, Jain AK, Kochhar R, Loganathan G, Misra SP, Ganesh Pai C, Pal S, Philip M, Pulimood A, Puri AS, Ray G, Singh SP, Sood A, Subramanian V. Indian Society of Gastroenterology consensus statements on Crohn's disease in India. Indian J Gastroenterol 2015; 34:3-22. [PMID: 25772856 DOI: 10.1007/s12664-015-0539-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2015] [Accepted: 01/29/2015] [Indexed: 02/07/2023]
Abstract
In 2012, the Indian Society of Gastroenterology's Task Force on Inflammatory Bowel Diseases undertook an exercise to produce consensus statements on Crohn's disease (CD). This consensus, produced through a modified Delphi process, reflects our current recommendations for the diagnosis and management of CD in India. The consensus statements are intended to serve as a reference point for teaching, clinical practice, and research in India.
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Chhabra P, Rana SS, Sharma V, Sharma R, Bhasin DK. Grey Turner's sign in acute necrotizing pancreatitis. Ann Gastroenterol 2015; 28:147. [PMID: 25608634 PMCID: PMC4289992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2014] [Accepted: 07/16/2014] [Indexed: 11/07/2022] Open
Affiliation(s)
- Puneet Chhabra
- Department of Gastroenterology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Surinder S. Rana
- Department of Gastroenterology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India,
Correspondence to: Dr Surinder Singh Rana, Department of Gastroenterology, PGIMER, Chandigarh 160012, India, Tel.: +91 172 2749123, Fax: +91 172 2744401, e-mail:
| | - Vishal Sharma
- Department of Gastroenterology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Ravi Sharma
- Department of Gastroenterology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Deepak K. Bhasin
- Department of Gastroenterology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
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Sharma V, Rana SS, Sharma RK, Kang M, Gupta R, Bhasin DK. A study of radiological scoring system evaluating extrapancreatic inflammation with conventional radiological and clinical scores in predicting outcomes in acute pancreatitis. Ann Gastroenterol 2015; 28:399-404. [PMID: 26129965 PMCID: PMC4480179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2014] [Accepted: 01/13/2015] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND A number of scoring systems are available to predict prognosis in acute pancreatitis (AP). The aim of the study was to compare extra-pancreatic inflammation on computed tomography (CT) (EPIC score) and renal rim sign with clinical scores (BISAP, SIRS) and conventional CT severity index (CTSI) and modified CTSI (MCTSI) in predicting persistent organ failure (POF), intervention and mortality. METHODS The demographic, clinical and radiographic data from patients with AP were retrospectively evaluated. The scores were evaluated by calculating receiver operator characteristic (ROC) curves and area under the ROC (AUROC). RESULTS Of the 105 patients (65 males; mean age 40.6±12.9 years) included, 8 died, 71 developed POF, and 16 needed intervention. The mean CTSI, MCTSI and EPIC scores were 5.8±3.0, 7.1±2.6 and 4.0±1.9 respectively. The AUROC for SIRS, BISAP, CTSI, MCTSI, Renal Rim Score and EPIC score in predicting POF were 0.65 (95%CI 0.53-0.78), 0.75 (95%CI 0.65-0.86), 0.66 (95%CI 0.54-0.78), 0.70 (95%CI 0.58-0.81), 0.64 (95%CI 0.52-0.76), 0.71 (95%CI 0.60-0.83), for radiological/endoscopic intervention were 0.50 (95%CI 0.35-0.65), 0.64 (95%CI 0.49-0.78), 0.51 (95%CI 0.36-0.66), 0.55 (95%CI 0.41-0.70), 0.51 (95%CI 0.36-0.67), 0.66 (95%CI 0.52-0.81), and for mortality 0.57 (95%CI 0.38-0.75), 0.90 (95%CI 0.83-0.97), 0.67 (95%CI 0.50-0.83), 0.68 (95%CI 0.51-0.85), 0.73 (95%CI 0.57-0.89) and 0.77 (95%CI 0.64-0.90) respectively. CONCLUSION The prognostic performance of various clinical and radiological scoring systems in AP is comparable with BISAP having the highest accuracy for predicting POF and mortality.
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Affiliation(s)
- Vishal Sharma
- Department of Gastroenterology (Vishal Sharma, Surinder S. Rana, Ravi K. Sharma, Deepak K. Bhasin), Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Surinder S. Rana
- Department of Gastroenterology (Vishal Sharma, Surinder S. Rana, Ravi K. Sharma, Deepak K. Bhasin), Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India,
Correspondence to: Dr Surinder Singh Rana, Assistant Professor, Department of Gastroenterology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012 India, Tel.: +91 172 2749123, Fax: +91 172 2744401, e-mail:
| | - Ravi K. Sharma
- Department of Gastroenterology (Vishal Sharma, Surinder S. Rana, Ravi K. Sharma, Deepak K. Bhasin), Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Mandeep Kang
- Department of Radiodiagnosis (Mandeep Kang), Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Rajesh Gupta
- Department of Surgery (Rajesh Gupta), Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Deepak K. Bhasin
- Department of Gastroenterology (Vishal Sharma, Surinder S. Rana, Ravi K. Sharma, Deepak K. Bhasin), Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
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Prabhakaran A, Bhasin DK, Rana SS, Bhadada SK, Bhansali A, Rao C, Gupta R, Khandelwal N. Bone mineral metabolism and bone mineral density in alcohol related and idiopathic chronic pancreatitis. ACTA ACUST UNITED AC 2014; 35:107-12. [PMID: 25470873 DOI: 10.7869/tg.189] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND There is limited information on the bone mineral metabolism in patients with chronic pancreatitis (CP). METHODS 103 patients with CP (all males: mean age 38.6 ± 20.64 yrs) and 40 age matched control males (mean age: 36.7 ± 20.70 yrs) were prospectively studied. Serum levels of 25 (OH) Vitamin D3, alkaline phosphatase (ALP), and parathyroid hormone (PTH) were measured. Bone mineral density (BMD) was measured using adual-energy X-ray absorptiometry (DEXA) scanner. RESULTS Seventy two (70%) patients had alcohol related chronic pancreatitis (ACP), 30 (29.1%) patients had idiopathic chronic pancreatitis (ICP) and one patient had post-traumatic chronic pancreatitis. Fifty nine (59.8%) patients had chronic calcific pancreatitis (CCP) and 39 (37.8%) patients were diabetic. Steatorrhea was noted in 21 (20.4%) patients. On comparison with controls, patients with chronic pancreatitis had significantly lower 25 (OH) Vitamin D3 levels (p = 0.01). On evaluation of bone mineral density (BMD) at lumbar spine, 46% patients were osteopenic and 12% patients were osteoporotic. On evaluation of BMD of femur, 30.1% patients were osteoporotic and 39.8% patients were osteopenic. No significant difference was found in the frequency of metabolic osteopathy between alcoholic and idiopathic groups (p = 0.108), calcific and non-calcific groups (p = 0.410), diabetic and non-diabetic groups (p = 0.126). smokers and non-smokers (p = 0.198), and patients with and without history of steatorrhea (p = 0.265) and indifferent severity groups ofupancreatitis (p = 0.910) CONCLUSIONS: Majority of patients with both ACP and ICP had low BMD and similar frequency of bone changes between various groups suggests that systemic inflammation may play an important role in its pathogenesis. Further detailed metabolic studies are necssary to define the pathogenic mechanism of metabolic osteopathy associated with chronic pancreatitis.
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Sharma V, Rana SS, Sharma RK, Gupta R, Bhasin DK. Clinical outcomes and prognostic significance of early vs. late computed tomography in acute pancreatitis. Gastroenterol Rep (Oxf) 2014; 3:144-7. [PMID: 25305375 PMCID: PMC4423459 DOI: 10.1093/gastro/gou067] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2014] [Accepted: 08/28/2014] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Guidelines recommend that contrast-enhanced computed tomography (CT) should be carried out 72 hours after onset of an attack of acute pancreatitis (AP). However, the exact time beyond 72 hours at which CT will produce the best diagnostic yield for local complications, or whether doing a CT early in acute pancreatitis has any adverse effect on the course of disease, is not clear. METHODS The medical records of 214 consecutive patients with AP were analysed retrospectively and these patients were divided into two groups: the early CT group (CT done at 4-5 days after the onset of pain) and the late CT group (CT done in days 6-14 following onset of pain). The two groups were compared for differences in clinical outcomes and prognostic information obtained from CT, such as detection of pancreatic necrosis and local complications, and CT severity index. RESULTS Of 214 patients [143 (66.8%) males; mean age 39.87 ± 13.52 years], 21 patients were excluded as they did not undergo CT or CT was done more than 14 days after onset of an attack of AP. The early CT group included 114 patients, whilst the late CT group had 79. The mean CT severity index was higher in the late CT group (6.65 ± 2.27 vs. 5.52 ± 2.7; P = 0.005). The incidence of persistent organ failure in the early group was no different from that of the late group (38.6% vs. 49.4%; P = 0.143). Local complications were detected more often in the late CT group (84.8% vs. 68.4%; P = 0.011). There was no difference between the two groups in the need for percutaneous drainage, surgery, or mortality (all P > 0.05). CONCLUSIONS Although performing early CT does not adversely affect the outcome in AP, CT carried out more than 5 days after the onset of symptoms may detect more local complications.
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Affiliation(s)
- Vishal Sharma
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India and Department of Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India
| | - Surinder S Rana
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India and Department of Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India
| | - Ravi K Sharma
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India and Department of Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India
| | - Rajesh Gupta
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India and Department of Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India
| | - Deepak K Bhasin
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India and Department of Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India
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Sharma V, Sharma R, Rana SS, Bhasin DK. Pancreatic encephalopathy: an unusual cause of asterixis. JOP 2014; 15:383-4. [PMID: 25076348 DOI: 10.6092/1590-8577/2291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
CONTEXT Pancreatic encephalopathy is the occurrence of neuropsychiatric abnormalities in setting of acute pancreatitis which is not otherwise explained by presence of electrolyte abnormities, or organic lesions. The pathogenesis of pancreatic encephalopathy is incompletely understood. The clinical presentation is variable. CASE REPORT A 60 year old male, a diabetic for 5 years, was admitted with three days of abdominal pain associated with vomiting and complicated by altered sensorium for one day. He developed asterixis during the course of his hospital stay. Other workup was non-contributory and patient improved with supportive management. CONCLUSION Asterixis has not hitherto been reported in pancreatic encephalopathy.
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Affiliation(s)
- Vishal Sharma
- Department of Gastroenterology, PGIMER, Chandigarh, India.
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Sharma V, Shanti Devi T, Sharma R, Chhabra P, Gupta R, Rana SS, Bhasin DK. Arterial pH, bicarbonate levels and base deficit at presentation as markers of predicting mortality in acute pancreatitis: a single-centre prospective study. Gastroenterol Rep (Oxf) 2014; 2:226-31. [PMID: 24994834 PMCID: PMC4124274 DOI: 10.1093/gastro/gou037] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Background. Arterial blood gas (ABG) parameters such as pH form part of multi-parameter scoring systems for predicting severe acute pancreatitis; however, literature on detailed evaluation of ABG alone in this context is scarce. Methods. Patients with acute pancreatitis presenting to our unit between January 2012 and November 2013 were prospectively studied. ABG analysis was done at admission and development of organ failure, any need for intervention, and mortality were noted. The association between various parameters of ABG analysis and the development of organ failure or local complications, need for interventions (endoscopic/radiological/surgical) and mortality were analysed. Results. Two hundred and five patients (mean age: 39.33 ± 13.85 years; 61.0% males) were prospectively studied. The aetiology of acute pancreatitis was alcohol in 93 patients (45.4%) and gall stone disease in 73 (35.6%). Organ failure developed in 71.2% patients and 83.9% had local complications. In 18% of patients, endoscopic/radiological/surgical interventions were needed and 14.6% died. The patients (n = 35) with metabolic acidosis (pH <7.35) suffered higher frequency of organ failure, need for interventions and mortality. Patients with low arterial bicarbonate levels, as well as higher base deficit, also displayed higher frequency of organ failure, need for interventions and mortality. The receiver operating characteristic (ROC) curves for pH <7.35, bicarbonate <22 meq/L and base deficit of >−4 meq/L for prediction of mortality were 0.771 (95% CI: 0.664–0.878), 0.707 (95% CI: 0.622–0.791) and 0.780 (95% CI: 0.693–0.867), respectively. Conclusion. Arterial pH, bicarbonate levels, and base deficit at presentation are useful early markers for predicting adverse outcome in acute pancreatitis.
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Affiliation(s)
- Vishal Sharma
- Department of Gastroenterology, Post Graduate Institute of Medical Education and Research, Chandigarh, India and Department of Surgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Thingbaijam Shanti Devi
- Department of Gastroenterology, Post Graduate Institute of Medical Education and Research, Chandigarh, India and Department of Surgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Ravi Sharma
- Department of Gastroenterology, Post Graduate Institute of Medical Education and Research, Chandigarh, India and Department of Surgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Puneet Chhabra
- Department of Gastroenterology, Post Graduate Institute of Medical Education and Research, Chandigarh, India and Department of Surgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Rajesh Gupta
- Department of Gastroenterology, Post Graduate Institute of Medical Education and Research, Chandigarh, India and Department of Surgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Surinder S Rana
- Department of Gastroenterology, Post Graduate Institute of Medical Education and Research, Chandigarh, India and Department of Surgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Deepak K Bhasin
- Department of Gastroenterology, Post Graduate Institute of Medical Education and Research, Chandigarh, India and Department of Surgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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Sharma V, Prasada KVR, Rana SS, Arun AC, Lal A, Gupta R, Bhasin DK. A modification of rendezvous technique for endoscopically treating transected common bile duct following cholecystectomy. Journal of Digestive Endoscopy 2014. [DOI: 10.4103/0976-5042.147503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
AbstractEndoscopic therapy is the standard of care for management of most benign biliary strictures. However, endoscopic therapy can fail in very tight strictures. We report a case of a 52-year-old lady who had complete bile duct transection with stricture after laparoscopic cholecystectomy. In initial attempt, at endoscopic retrograde cholangiopancreatography (ERCP), guidewire could not be negotiated endoscopically across the narrowing as there was complete cut off of the bile duct and so a percutaneous transhepatic biliary drainage (PTBD) was done and subsequently internalized into the duodenum. We cannulated the internalized end of PTBD catheter with the standard ERCP cannula with guidewire and advanced it across the biliary stricture. PTBD catheter was withdrawn externally, and the guidewire was left in the left ductal system. We report this innovation as this may be helpful in managing patients with ERCP after an initial PTBD has been successfully internalized into the duodenum.
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Affiliation(s)
- Vishal Sharma
- Departments of Gastroenterology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - K. V. Raghavendra Prasada
- Departments of Gastroenterology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Surinder S. Rana
- Departments of Gastroenterology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - A. C. Arun
- Departments of Gastroenterology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Anupam Lal
- Department of Gastroenterology, Radiodiagnosis
| | - Rajesh Gupta
- Department of Gastroenterology, Surgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Deepak K. Bhasin
- Departments of Gastroenterology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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50
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Rana SS, Dhaliwal HS, Sharma V, Chaudhary V, Bhasin DK. Pancreatic stent eroding into the stomach. Endoscopy 2014; 45 Suppl 2 UCTN:E361-2. [PMID: 24285048 DOI: 10.1055/s-0033-1344774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Affiliation(s)
- S S Rana
- Department of Gastroenterology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
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