Jahangeer Basha

Endoscopic management of pancreatic fluid collections-revisited

The development of pancreatic fluid collections (PFC) is one of the most common complications of acute severe pancreatitis. Most of the acute pancreatic fluid collections resolve and do not require endoscopic drainage. However, a substantial proportion of acute necrotic collections get walled off and may require drainage. Endoscopic drainage of PFC is now the preferred mode of drainage due to reduced morbidity and mortality as compared to surgical or percutaneous drainage. With the introduction of new metal stents, the efficiency of endoscopic drainage has improved and the task of direct endoscopic necrosectomy has become easier. The requirement of re-intervention is less with new metal stents as compared to plastic stents. However, endoscopic drainage is not free of adverse events. Severe complications including bleeding, perforation, sepsis and embolism have been described with endoscopic approach to PFC. Therefore, the endoscopic management of PFC is a multidisciplinary affair and involves interventional radiologists as well as GI surgeons to deal with unplanned adverse events and failures. In this review we discuss the recent advances and controversies in the endoscopic management of PFC.

Endoscopic Ultrasound–guided Drainage of Walled-off Necrosis in Children With Fully Covered Self-expanding Metal Stents

Objectives: Endoscopic ultrasound (EUS)-guided drainage with fully covered self-expanding metallic stents (FCSEMS) has been successfully used in adult patients. The utility of FCSEMS in children with walled-off necrosis (WON) is, however, unknown. The aim of present study was to evaluate the feasibility, safety, and efficacy of EUS drainage of WON using FCSEMS in children. Methods: We retrospectively evaluated the data of children (18 years or younger) who underwent EUS drainage of WON using FCSEMS at our institution. All FCSEMS were removed between 1 and 3 months. Feasibility, safety, and efficacy were analysed. Results: Twenty-one children (20 boys, mean age 14.9 ± 2.34 years, range 9–18 years) underwent EUS-guided drainage of WON with FCSEMS. The median size of WON was 88 mm (55–148 mm). The median interval between onset of acute pancreatitis and EUS guided drainage was 58 days (range 30–288 days). The technical and clinical success rates were 100% and 95%, respectively. Nasocystic tube was placed in 3 children for lavage. Endoscopic necrosectomy was not required in any of the children. There were no major complications. Minor complications included bleeding (2), stent migration (1), and difficulty in removal of stent (1). After a median follow-up of 360 days (range: 30–1020 days), there was 1 recurrence of WON. Conclusions: EUS drainage of WON using specially designed FCSEMS is safe and efficacious in children. The utility of FCSEMS in children should be further explored and compared with plastic stents.

Endoscopic drainage of pancreatic fluid collections: Long‐term outcomes in children

Endoscopic drainage of pancreatic fluid collections (PFC) is the standard of care in adult patients. The literature is limited in children. In the present study, we aim to evaluate the safety and long‐term efficacy of endoscopic ultrasound (EUS)‐guided drainage of PFC in children.

Sa1351 Neutrophil Gelatinase-Associated Lipocalin: An Early Biomarker for Predicting Acute Kidney Injury in Patients With Acute Pancreatitis

GTL alone. CONCLUSIONS: High concentrations of UFA, IL-1beta and IL-8 in necrosis fluid relative to NIC fluids supports these to be the potential culprits in necrotic cell death as evidenced by high DNA content in the post-necrotic fluid. The ability of orlistat to reduce serum lipase, NEFA, UFA, LA concentrations in rat serum demonstrates its efficacy as a lipase inhibitor in this model. The high mortality, necrosis, IL-1beta and IL-8 concentrations, distant organ injury in GTL infused rats, and reduction of these with orlistat supports lipolytic generation of UFAs to be the driver of inflammation and necrosis. Therefore, the combined data suggests that lipotoxicity may drive inflammation and necrosis in human acute pancreatitis. Table 1: Human Data

Endoscopic drainage of pancreatic fluid collections by use of a novel biflanged stent with electrocautery-enhanced delivery system

Endoscopic drainage is currently the preferred modality of drainage for pancreatic fluid collections (PFCs) because of the ease of the procedure, reduced cost, shorter hospital stay, and the reduced morbidity and mortality compared with traditional surgical drainage. Plastic stents used for endoscopic drainage may become blocked with the passage of time, leading to adverse events requiring reinterventions, especially in PFCs with significant debris (ie, walled-off necrosis [WON]). Novel large-caliber metal stents (LCMSs) are less prone to spontaneous occlusions and therefore, provide efficient drainage of PFCs. Large-caliber metal stents have been broadly classified as either lumen-apposing metal stents (LAMSs) or biflanged metal stents (BFMSs). The safety and efficacy of these stents have been established in multiple studies. The deployment of novel metal stents involves a series of well-coordinated steps including real-time endosonography, fluoroscopy, and endoscopic imaging. Recently, LAMSs with an electrocautery-enhanced delivery system (Hot AXIOS; Boston Scientific Corp, Marlborough, Mass, USA) have been introduced. The stent assembly has inbuilt multiple steps for deployment, making the drainage procedure easier. In this study, we aimed to evaluate the feasibility and safety of a novel BFMS with electrocautery-enhanced delivery system (EC-BFMS) (Video 1, available online at www.VideoGIE.org).

Anemia in celiac disease is multifactorial in etiology: A prospective study from India: Anemia in celiac disease

Anemia is one of the most common extraintestinal manifestations of celiac disease (CD), with iron deficiency anemia (IDA) being the predominant cause. However, anemia in CD can have varied etiologies, including mixed nutritional deficiency. We aimed to study the prevalence and etiology of anemia in CD in a north Indian population.

Recurrent acute pancreatitis due to pancreatic duct ascariasis in a young man

A 26-year-old man presented with abdominal pain and vomiting for 7 days. He had had similar complaints a few months previously. His laboratory evaluation showed a raised serum amylase (878 IU/dL) and a bulky pancreas on ultrasonography of the abdomen. Other etiological work-up for acute pancreatitis was normal. Contrast-enhanced computed tomography (CT) scanning revealed a normal pancreas with a linear hypodense structure in the second part of the duodenum (▶Fig. 1). Endoscopic ultrasound (EUS) was performed to further evaluate the cause of this patient’s recurrent pancreatitis. A linear echoendoscope (UCT-180; Olympus, Tokyo, Japan) was used for the pancreatobiliary examination. The gall bladder and common bile duct were normal and anechoic. Evaluation of the pancreas and pancreatic duct was initiated in the second part of the duodenum with the scope in the short position. At the level of the papilla, two linear parallel echogenic lines without any acoustic shadow (the “strip sign”) and a thin central hypoechoic rim (the “inner tube sign”) were seen within the pancreatic duct (▶Fig. 2; ▶Video1). Tracing the lines ▶ Fig. 1 Contrast-enhanced computed tomography (CT) scan showing a linear hypodense structure in the second part of the duodenum. ▶ Fig. 2 Endoscopic ultrasound showing the characteristic “strip sign” (two linear parallel echogenic lines without any acoustic shadow; white arrow) and central hypoechoic rim (inner tube sign; red arrow) typical of ascariasis in the pancreatic duct. ▶ Fig. 3 Endoscopic view showing the Ascaris worm popping out through the papilla.

Endoscopic Drainage of Walled Off Necrosis in a Child With Metal Stent

Journal of Pediatric Gastroenterology and Nutrition Publish Ahead of Print DOI: 10.1097/MPG.0000000000001524 Endoscopic Drainage of Walled Off Necrosis in a Child with Metal Stent Zaheer Nabi, Sundeep Lakhtakia, Jahangeer Basha, D Nageshwar Reddy Authors 1. Zaheer Nabi, M.D, D.N.B. Consultant gastroenterologist, Asian institute of Gastroenterology, Hyderabad (zaheernabi1978@gmail.com) 2. Sundeep Lakhtakia, M.D. D.M. Consultant gastroenterologist, Asian institute of Gastroenterology, Hyderabad (drsundeeplakhtakia@gmail.com) 3. Jahangeer Basha, M.D. D.M. Consultant gastroenterologist, Asian institute of Gastroenterology, Hyderabad (drjahangeer09@gmail.com) 4. D. Nageshwar Reddy M.D. D.M, Chairman and Chief Gastroenterologist, Asian institute of Gastroenterology, Hyderabad (aigindia@yahoo.co.in)

Su1296 Co-Existence of Pancreatic and Liver Disease in Alcoholics: A Prospective and Retrospective Analysis

and comorbidities, in patients with liver cirrhosis, CDI was independently associated with an increased LOS (adjusted mean difference, 5.2 days, 95% CI, 4.6 5.8), higher all-cause in-hospital mortality (OR 1.4, 95% CI, 1.3 1.5), and higher DTCF (3.9, 95% CI, 3.7 4.0), all p,0.0001. Conclusions: CDI is a major complication in liver cirrhosis patients, and is independently associated with poor outcomes, including increased LOS, in-hospital mortality and DTCF.

Endoscopic ultrasound assisted etiological localization in acute pancreatitis

Hyperparathyroidism is an uncommon cause of pancreatitis and one should look for its telltale evidence on history (renal stone disease) and investigations (hypercalcemia). Endosonography has an upcoming role in the management of acute pancreatitis, especially in the presence of fluid collection. We report a case of parathyroid adenoma related acute pancreatitis complicated with pseudocyst, which was managed with percutaneous drainage and endosonographic localization of the adenoma to the left parathyroid gland. This patient underwent sestamibi scanning, which confirmed its presence and underwent surgical excision of the adenoma. Endosonography should be included in the work up of patients with unclear etiology and thyroids should be routinely scanned for parathyroid adenomas. One should always look outside the box to get clues for diseases inside the box.