Indian Journal of Gastroenterology最新文献

Background and objectives: Chronic pancreatitis (CP) is a fibroinflammatory disease causing functional injury. Abdominal pain is the predominant symptom negatively impacting the quality of life. The Comprehensive Pain Assessment Tool (COMPAT-SF) questionnaire, designed and validated to assess pain in CP, was previously only available in English and Danish. Given the high prevalence of CP in India, translating and validating COMPAT-SF into different languages becomes crucial.

Methods: The COMPAT-SF underwent translation into three Indian languages (Hindi, Telugu and Bengali) and was back-translated to English to ensure cross-cultural equivalence. Validation was conducted at two tertiary care centers in India. As Hindi is the most widespread language, bilingual CP patients answered the COMPAT-SF in Hindi and English at a three-week interval. All sub-group answers were compared with patient data from the US. Structural equation modeling and confirmatory factor analysis were employed for validation.

Results: Total 64 patients (19 Hindi-speaking,15 Telugu and 30 Bengali) were included and compared with 91 English-speaking patients. Translation adequacy was confirmed with > 85% concordance. Despite modest Cronbach alpha values in reliability analysis, structural equation modeling demonstrated high consistency with the original COMPAT-SF study. Some cultural differences in responses were observed, but the responses were comparable overall. Confirmatory factor analysis on the pooled data indicated an acceptable model fit and the Hindi version showed good accordance with the English version.

Conclusion: The translated COMPAT-SF versions proved to be valid and reliable pain assessment tools for CP patients. The study underscores the importance of addressing pain comprehensively.

The Indian Society of Gastroenterology has developed an evidence-based practice guideline for the management of caustic ingestion-related gastrointestinal (GI) injuries. A modified Delphi process was used to arrive at this consensus containing 41 statements. These statements were generated after two rounds of electronic voting, one round of physical meeting, and extensive review of the available literature. The exact prevalence of caustic injury and ingestion in developing countries is not known, though it appears to be of significant magnitude to pose a public health problem. The extent and severity of this preventable injury to the GI tract determine the short and long-term outcomes. Esophagogastroduodenoscopy is the preferred initial approach for the evaluation of injury and contrast-enhanced computed tomography is reserved only for specific situations. Low-grade injuries (Zargar grade ≤ 2a) have shown better outcomes with early oral feeding and discharge from hospital. However, patients with high-grade injury (Zargar grade ≥ 2b) require hospitalization as they are at a higher risk for both short and long-term complications, including luminal narrowing. These strictures can be managed endoscopically or surgically depending on the anatomy and extent of stricture, expertise available and patients' preferences. Nutritional support all along is crucial for all these patients until nutritional autonomy is established.

Background and objectives: Chronic liver diseases (CLD) may progress to cirrhosis, decompensation and death. An intervening insult may lead to acute decompensation (AD); patients with AD may fulfil criteria for acute-on-chronic liver failure (AD-ACLF). While the outcome of ACLF and priority for liver transplantation have been studied, data on outcome in a non-transplant setting is sparse. We evaluated three international consensus criteria for definition of ACLF to determine the number of patients satisfying these definitions and their accuracy in predicting mortality and compare mortality in a non-transplant setting.

Methods: Total 341 consecutive patients with CLD of any etiology were enrolled and followed up. All significant clinical events and changes in laboratory data were noted to classify patients into no AD, AD-ACLF and AD-non-ACLF.

Results: Total 150 (44%) patients had non-alcoholic fatty liver disease as etiology. As many as 197 (57.8%) patients had AD; of these, 54 (27.4%) met at least one definition of ACLF: 50 (92.6%) fulfilled EASL-CLIF criteria, 31 (57.4%) NACSELD and 22 (40.7%) APASL. The most common precipitating event (59.2%) was infection. Forty-six (13.5%) patients died during the study period - 52% of those with AD-ACLF and 12.6% with AD-non-ACLF (p < 0.00001). The accuracy of EASL-CLIF, NACSELD and APASL definitions in determining mortality was 79.7%, 86.3% and 77.7%, respectively.

Conclusion: Total 16% of patients with CLD developed AD-ACLF by any definition; one-half of them died. EASL-CLIF criteria identified maximum number of patients with AD-ACLF, but NACSELD criteria had highest accuracy for predicting mortality in AD-ACLF. These findings may help prioritize patients with ACLF for intensive care in the absence of easy access to liver transplantation.

Background and objectives: Peritoneal metastasis in gastric cancer is associated with a very poor prognosis with a median overall survival of seven to 15 months if treated with systemic chemotherapy only. Studies have shown improved survival with cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) in selected group of patients, when compared to systemic chemotherapy alone. In spite of promising results, this is not the standard of care till date. The aim of our study was to evaluate the long-term outcome for the patients of gastric cancer with peritoneal metastases undergoing cytoreductive surgery and HIPEC at our institute.

Methods: Retrospective analysis of prospectively maintained data of all patients, who underwent cytoreductive surgery and HIPEC during the period of 2015-2023, was performed. All relevant pre-operative, peri-operative, post-operative and histopathological data was analyzed and overall survival and disease-free survival calculated.

Results: Twenty-three patients of gastric cancer with peritoneal metastasis (PCI < / = 7) underwent cytoreductive surgery and HIPEC during the study period. At a median follow-up of 12 months, median disease-free survival (DFS) and overall survival (OS) were 12 months and 35 months, respectively. One-year and three-year DFS were 48.5% and 23%, respectively. One-year and three-year OS was 85% and 45.4%, respectively.

Conclusion: Cytoreductive surgery and HIPEC can be considered to be safe and effective treatment strategy in a select group of gastric cancer patients with peritoneal metastasis leading to a meaningful survival as compared to palliative systemic chemotherapy.

Background: Therapeutic plasma exchange (TPE) has emerged as a promising treatment option for pediatric liver failure (PLF) either as a standalone therapy or as a bridge to liver transplant; however, its precise impact on survival outcomes has not been investigated systematically to date. This meta-analysis aims to evaluate the effect of TPE on survival of pediatric patients with liver failure.  METHODS: PubMed, Scopus and Embase databases were searched to include all studies till August 2024 reporting the effect of TPE on survival of acute and acute-on-chronic liver failure patients of age < 18 years. Primary outcome measures were overall survival (OS) and transplant-free survival (TFS) at Day ≥ 28 in pediatric acute liver failure (PALF) and pediatric acute-on-chronic liver failure (pACLF) patients undergoing TPE. The secondary outcome measure was to determine changes in biochemical parameters (international nrmalized ratio [INR], bilirubin and ammonia) pre and post-TPE in them.

Results: Twelve studies (8 = exclusive PALF cohorts and 4 = combined PALF + pACLF cohorts) comprising 310 patients (273 = PALF and 37 = pACLF) who received TPE were included. Pooled OS at Day ≥ 28 for PLF after TPE is 61% (95% CI: 55-66%, p = 0.03, I² = 49%). The estimated pooled TFS in them was 35% (95% CI: 29-41%, p = < 0.01, I² = 84%). On sub-group analysis, the standard-volume TPE group had both higher OS and TFS in comparison to the high-volume sub-group. There was a significant improvement in all three biochemical parameters post-TPE compared to pre-TPE values. None of the included studies reported any TPE-related mortality or potentially fatal side effects.

Conclusion: TPE shows the potential to improve overall survival in pediatric liver failure, mostly acting as a bridge to liver transplant or native liver recovery. Further, well-designed, adequately powered, randomized-controlled trials are needed to confirm TPE's survival benefit in PLF.

Clips, devices and sprays are important tools in the armamentarium of interventional endoscopists which are needed to tackle challenging clinical scenarios. There has been a revolutionary change in the design and features of modern-day endoscopic clips that has greatly increased its applicability. Both through-the-scope clip (TTS clip) and over-the-scope clips (OTSC) have their role in day-to-day clinical practice with each having some advantages and disadvantages. Sprays have been an important adjunct to clips which can be extremely useful in difficult clinical scenarios where clips may not work. There has been growing evidence with regard to its use in literature. Many different types of TTS clips are available that have combination of different properties such as size, tail length, rotatability, re-openability and tensile strength. Two types of OTSC are available which differs according to their design and mechanism of application. Though TTS clips are still most used clips in day-to-day practice, we recommend that OTSCs should be used as a primary modality in patients who are at high risk of rebleeding such as patients on dual anti-platelets, those requiring to restart anticoagulation early, patients with chronic kidney disease and in large (> 1.5 cm) fibrotic ulcer bleeds. Herein, we describe technical and clinical aspects, types, applications and optimal usage techniques of different clips, devices and sprays commonly used in endoscopy.

Introduction: Radiological interventions in Budd-Chiari syndrome (BCS) include anatomical recanalization of the hepatic vein (HV), inferior vena cava (IVC) angioplasty and stenting. In case of technical difficulty and anatomical non-feasibility, an ultrasound-guided direct intrahepatic portosystemic shunt (DIPSS) is created. We aimed at evaluating the outcome of patients managed with DIPSS and comparing it with anatomical recanalization.

Methods: We retrieved the data of patients with BCS managed at our institution between 2011 and 2021. Safety, efficacy and long-term outcomes were assessed and compared between radiological interventions.

Results: Total 236 patients with BCS underwent radiological intervention in the study period. As many as 96 patients were excluded and 140 patients were included in the final analysis. The majority were males (F:M = 54:86). The median age at the time of diagnosis was 30 years (interquartile range: 25-37 years). The median follow-up period was 58 (14-72) months. On imaging, 53% (74) patients had combined HV and IVC block followed by isolated HV block in 54 patients (38.5%) and isolated IVC block in 12 patients (8.5%). As many as 32 patients were managed by DIPSS. Among others, 56 patients underwent IVC angioplasty with HV stenting and 30 required HV angioplasty and stenting. DIPSS had a comparable technical success rate (100% vs. 98.2% vs. 96%, respectively p > 0.5). However, the median stent patency was higher in the DIPSS group (72 [48-96] months) compared to IVC angioplasty and HV stenting (46 [36-60] months; p = 0.02) and HV angioplasty-stenting (42 [30-48] months; p = 0.04) groups. They had similar re-thrombosis rates (28%, 34% and 21%, respectively; p > 0.05). Overall complications were rare (3.5%) and no patient in the DIPSS group had adverse events.

Conclusion: DIPSS is a safe and effective salvage procedure with an excellent long-term outcome in patients with BCS. It has a longer median stent patency compared to the anatomical recanalization group.