Shanmuganathan Subramanyam, Vatsal Bachkaniwala, C. V. Vikranth, P. Ganesh
A duodenal periampullary diverticulum can cause changes in the local anatomy and pose a challenge for the cannulation of the bile duct. Cannulation may be much more difficult if the ampulla is located within the diverticula. We present the case of a 40-year-old man who developed obstructive jaundice and cholangitis because of the duodenal diverticula mechanically obstructing the common bile duct (Lemmel's syndrome). The papilla was located entirely within the duodenal diverticula and was brought out after placing endoscopic variceal ligation (EVL) bands. Biliary access and stenting could be done easily, after exposing the papilla. There were no complications during the procedure or the recovery period.
{"title":"A Novel Technique of Intradiverticular Papillary Canulation Aided by EVL Band Ligator in a Case of Lemmel’s Syndrome","authors":"Shanmuganathan Subramanyam, Vatsal Bachkaniwala, C. V. Vikranth, P. Ganesh","doi":"10.1055/s-0041-1739565","DOIUrl":"https://doi.org/10.1055/s-0041-1739565","url":null,"abstract":"A duodenal periampullary diverticulum can cause changes in the local anatomy and pose a challenge for the cannulation of the bile duct. Cannulation may be much more difficult if the ampulla is located within the diverticula. We present the case of a 40-year-old man who developed obstructive jaundice and cholangitis because of the duodenal diverticula mechanically obstructing the common bile duct (Lemmel's syndrome). The papilla was located entirely within the duodenal diverticula and was brought out after placing endoscopic variceal ligation (EVL) bands. Biliary access and stenting could be done easily, after exposing the papilla. There were no complications during the procedure or the recovery period.","PeriodicalId":43098,"journal":{"name":"Journal of Digestive Endoscopy","volume":null,"pages":null},"PeriodicalIF":0.7,"publicationDate":"2022-01-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43874065","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
A. Balekuduru, M. Sahu, S. Bongu, A. Satyal, S. Devarasetty, R. Matta, Y. P. Reddy
Background and Study Aims In the coronavirus disease 2019 (COVID-19) pandemic, patients undergoing esophagogastroduodenoscopy (EGD) and colonoscopy on the same day (bidirectional endoscopy [BDE]) have increased. The aims of the study were to compare the procedure times, benefits, and safety of same-day BDE and conventional serial endoscopic examination (SEE). Patients and Methods All the patients undergoing evaluation with either BDE or SEE were prospectively enrolled at Ramaiah Medical College and Hospitals, Bangalore, from 1st December 2020 to 31st May 2021. EGD was immediately followed by colonoscopy in BDE. In SEE, EGD was followed by colonoscopy in 1 or 2 days. Clinical data and results were collected and evaluated. Results Two hundred consecutive patients who consented for BDE were enrolled in the study. The mean ± standard deviation (range) age of the patients was 45 ± 14.5 (22-60) years. Majority (124 [62%]) were men. The outcome measures of Boston Bowel Preparation Scale with the excellent/good preparation score and polyp detection rate were similar in both groups (p = 0.4). The total procedure time was significantly higher in the SEE group than in the BDE (p < 0.001). There were no adverse events noted in the study. The overall patient experience and satisfaction were higher in BDE than in SEE without any difference in the quality of the procedures (p < 0.001). Patients with weight loss and anemia were more likely to have a positive test result than the patients with abdominal pain and diarrhea. Conclusions In conclusion, same-day BDE is advised for patients with anemia and weight loss which can reduce the number of hospital visits and improve patient satisfaction in COVID times.
{"title":"Bidirectional Endoscopy-A Trend for Future in COVID Era","authors":"A. Balekuduru, M. Sahu, S. Bongu, A. Satyal, S. Devarasetty, R. Matta, Y. P. Reddy","doi":"10.1055/s-0042-1744443","DOIUrl":"https://doi.org/10.1055/s-0042-1744443","url":null,"abstract":"Background and Study Aims In the coronavirus disease 2019 (COVID-19) pandemic, patients undergoing esophagogastroduodenoscopy (EGD) and colonoscopy on the same day (bidirectional endoscopy [BDE]) have increased. The aims of the study were to compare the procedure times, benefits, and safety of same-day BDE and conventional serial endoscopic examination (SEE). Patients and Methods All the patients undergoing evaluation with either BDE or SEE were prospectively enrolled at Ramaiah Medical College and Hospitals, Bangalore, from 1st December 2020 to 31st May 2021. EGD was immediately followed by colonoscopy in BDE. In SEE, EGD was followed by colonoscopy in 1 or 2 days. Clinical data and results were collected and evaluated. Results Two hundred consecutive patients who consented for BDE were enrolled in the study. The mean ± standard deviation (range) age of the patients was 45 ± 14.5 (22-60) years. Majority (124 [62%]) were men. The outcome measures of Boston Bowel Preparation Scale with the excellent/good preparation score and polyp detection rate were similar in both groups (p = 0.4). The total procedure time was significantly higher in the SEE group than in the BDE (p < 0.001). There were no adverse events noted in the study. The overall patient experience and satisfaction were higher in BDE than in SEE without any difference in the quality of the procedures (p < 0.001). Patients with weight loss and anemia were more likely to have a positive test result than the patients with abdominal pain and diarrhea. Conclusions In conclusion, same-day BDE is advised for patients with anemia and weight loss which can reduce the number of hospital visits and improve patient satisfaction in COVID times.","PeriodicalId":43098,"journal":{"name":"Journal of Digestive Endoscopy","volume":null,"pages":null},"PeriodicalIF":0.7,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"57973790","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Surgical necrosectomy has been the traditional management for pancreatic necrosis and is done using blunt dissection. However, lack of dedicated endoscopic accessories has been a major limitation in direct endoscopic necrosectomy (DEN). Standard endoscopic accessories cannot effectively remove large necrotic material. Also, diameter of instrument channel of the endoscope limits the ability to use large-diameter graspers that can remove large chunks of necrotic material. In this news, we discuss a recent study that has evaluated a new powered endoscopic debridement system for DEN.
{"title":"Novel Resection System for Direct Endoscopic Necrosectomy of Walled-Off Pancreas Necrosis: Have We Conquered the Final Frontier?","authors":"S. Rana, Rajesh Gupta","doi":"10.1055/s-0041-1741066","DOIUrl":"https://doi.org/10.1055/s-0041-1741066","url":null,"abstract":"Surgical necrosectomy has been the traditional management for pancreatic necrosis and is done using blunt dissection. However, lack of dedicated endoscopic accessories has been a major limitation in direct endoscopic necrosectomy (DEN). Standard endoscopic accessories cannot effectively remove large necrotic material. Also, diameter of instrument channel of the endoscope limits the ability to use large-diameter graspers that can remove large chunks of necrotic material. In this news, we discuss a recent study that has evaluated a new powered endoscopic debridement system for DEN.","PeriodicalId":43098,"journal":{"name":"Journal of Digestive Endoscopy","volume":null,"pages":null},"PeriodicalIF":0.7,"publicationDate":"2021-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42628442","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
A. Gandhi, Mangesh Borkar, H. Bapaye, R. Pujari, A. Bapaye
Management of infected lesser sac walled-off pancreatic necrosis (WOPN) is technically challenging and involves endoscopic ultrasound (EUS)-guided transmural drainage using either lumen-apposing metal stent (LAMS) or multiple plastic stents as the standard approach. A step-up approach—drainage followed by additional direct endoscopic necrosectomy (DEN) whenever required—has been a standard recommendation. Collections extending to the paracolic gutter are difficult to manage endoscopically and often require additional surgical intervention. In this video case, we describe a combined approach using EUS-guided LAMS and percutaneous fully covered self-expandable metal stent-guided DEN (e-DEN + p-DEN) for successful management of an infected lesser sac WOPN with paracolic extension.
{"title":"Combined EUS LAMS and Percutaneous Fully Covered SEMS-Guided Direct Endoscopic Necrosectomy (e-DEN + p-DEN) for Walled-Off Pancreatic Necrosis with Paracolic Extension","authors":"A. Gandhi, Mangesh Borkar, H. Bapaye, R. Pujari, A. Bapaye","doi":"10.1055/s-0041-1741388","DOIUrl":"https://doi.org/10.1055/s-0041-1741388","url":null,"abstract":"Management of infected lesser sac walled-off pancreatic necrosis (WOPN) is technically challenging and involves endoscopic ultrasound (EUS)-guided transmural drainage using either lumen-apposing metal stent (LAMS) or multiple plastic stents as the standard approach. A step-up approach—drainage followed by additional direct endoscopic necrosectomy (DEN) whenever required—has been a standard recommendation. Collections extending to the paracolic gutter are difficult to manage endoscopically and often require additional surgical intervention. In this video case, we describe a combined approach using EUS-guided LAMS and percutaneous fully covered self-expandable metal stent-guided DEN (e-DEN + p-DEN) for successful management of an infected lesser sac WOPN with paracolic extension.","PeriodicalId":43098,"journal":{"name":"Journal of Digestive Endoscopy","volume":null,"pages":null},"PeriodicalIF":0.7,"publicationDate":"2021-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44629920","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Peroral endoscopic myotomy (POEM) is an accepted treatment for achalasia cardia (AC), and results are comparable to those of laparoscopic Heller myotomy (LHM). In recent years, several reports have confirmed higher incidence of gastroesophageal reflux (GER) following POEM. This review evaluates the current evidence regarding post-POEM GER, critically examines the potential contributing factors responsible for GER, limitations of the current available functional testing, and precautions and preventive measures, and provides future directions for research. Factors conclusively contributing to increased post-POEM GER include injury to the sling fibers of the lower esophageal sphincter, length of gastric myotomy > 2 cm, and others. Historically, these same factors have been implicated for development of GER after surgical (laparoscopic) myotomy. Although less invasive, optimal technique of POEM may be important to control post-POEM GER. Most post-POEM GER occurs during the immediate post-POEM period, is mild, and is easily treatable using proton-pump inhibitors. GER incidence plateaus at 2 years and is comparable to that after LHM. Patients should therefore be prescribed proton-pump inhibitors for at least 2 years. Antireflux procedures (ARPs) are infrequently required in these patients as the incidence of refractory GER is low. Novel ARPs have been recently described and are currently under evaluation. Conclusive diagnosis of GER is a clinical challenge. Most patients are asymptomatic, and GER is diagnosed only on abnormal esophageal acid exposure (EAE). Studies have demonstrated that current measures to diagnose GER are inadequate, inaccurate, and cannot differentiate between true GER and abnormal EAE due to food fermentation in the distal esophagus. The Lyon Consensus criteria should be implemented for confirmation of diagnosis of GER. Finally, the review recommends an evidence-based clinical algorithm for evaluation and management of post-POEM GER and provides guidelines for future research in this field.
{"title":"Gastroesophageal Reflux after Peroral Endoscopic Myotomy: Myth or Reality?","authors":"A. Bapaye, A. Gandhi, J. Bapaye","doi":"10.1055/s-0041-1740489","DOIUrl":"https://doi.org/10.1055/s-0041-1740489","url":null,"abstract":"Peroral endoscopic myotomy (POEM) is an accepted treatment for achalasia cardia (AC), and results are comparable to those of laparoscopic Heller myotomy (LHM). In recent years, several reports have confirmed higher incidence of gastroesophageal reflux (GER) following POEM. This review evaluates the current evidence regarding post-POEM GER, critically examines the potential contributing factors responsible for GER, limitations of the current available functional testing, and precautions and preventive measures, and provides future directions for research. Factors conclusively contributing to increased post-POEM GER include injury to the sling fibers of the lower esophageal sphincter, length of gastric myotomy > 2 cm, and others. Historically, these same factors have been implicated for development of GER after surgical (laparoscopic) myotomy. Although less invasive, optimal technique of POEM may be important to control post-POEM GER. Most post-POEM GER occurs during the immediate post-POEM period, is mild, and is easily treatable using proton-pump inhibitors. GER incidence plateaus at 2 years and is comparable to that after LHM. Patients should therefore be prescribed proton-pump inhibitors for at least 2 years. Antireflux procedures (ARPs) are infrequently required in these patients as the incidence of refractory GER is low. Novel ARPs have been recently described and are currently under evaluation. Conclusive diagnosis of GER is a clinical challenge. Most patients are asymptomatic, and GER is diagnosed only on abnormal esophageal acid exposure (EAE). Studies have demonstrated that current measures to diagnose GER are inadequate, inaccurate, and cannot differentiate between true GER and abnormal EAE due to food fermentation in the distal esophagus. The Lyon Consensus criteria should be implemented for confirmation of diagnosis of GER. Finally, the review recommends an evidence-based clinical algorithm for evaluation and management of post-POEM GER and provides guidelines for future research in this field.","PeriodicalId":43098,"journal":{"name":"Journal of Digestive Endoscopy","volume":null,"pages":null},"PeriodicalIF":0.7,"publicationDate":"2021-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45567178","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Esophageal motility disorders (EMDs) form a significant part of a busy endoscopist's practice. Endoscopy plays an all-encompassing role in the diagnosis and management of EMDs including achalasia cardia. The focus on in-vogue third-space endoscopic procedures such as per-oral endoscopic myotomy often digresses the important role of endoscopy. Endoscopic evaluation forms the part of standard first-line evaluation of any dysphagia and serves to rule out a secondary cause such as an esophagogastric junction malignancy and eosinophilic esophagitis. Moreover, endoscopic evaluation may itself provide corroborative evidence that may contribute to the diagnosis of the motility disorder. Achalasia cardia may present with a wide spectrum of endoscopic findings from being entirely normal and the well-known and pathognomonic dilated sigmoid-shaped esophagus with food residue, to lesser-known ornate signs. The evidence on the role of endosonography in EMDs is conflicting and largely restricted to evaluation of pseudoachalasia. High-resolution manometry (HRM) remains the gold standard in the diagnosis of EMDs. Endoscopists must also keep abreast of the latest iteration of the Chicago classification version 4.0, which differs significantly from its predecessor in being more stringent in making diagnosis of esophagogastric junction outflow obstruction and disorders of peristalsis since these manometric findings may be seen in normal individuals and may be mimicked by opioid use and gastroesophageal reflux. The latest rendition also includes the use of provocative maneuvers and testing in both supine and sitting posture. Despite being the gold standard, there are certain lacunae in the use and interpretation of the Chicago classification of which the users should be well aware. Emerging technologies such as functional lumen imaging probe and planimetry, and timed barium esophagogram fill the lacuna in diagnosis of these motility disorders, which at times is beyond the resolution of HRM.
{"title":"Esophageal Motility Disorders: Are We Missing in Our Busy Endoscopy Practice?","authors":"A. Elhence, U. Ghoshal","doi":"10.1055/s-0041-1741064","DOIUrl":"https://doi.org/10.1055/s-0041-1741064","url":null,"abstract":"Esophageal motility disorders (EMDs) form a significant part of a busy endoscopist's practice. Endoscopy plays an all-encompassing role in the diagnosis and management of EMDs including achalasia cardia. The focus on in-vogue third-space endoscopic procedures such as per-oral endoscopic myotomy often digresses the important role of endoscopy. Endoscopic evaluation forms the part of standard first-line evaluation of any dysphagia and serves to rule out a secondary cause such as an esophagogastric junction malignancy and eosinophilic esophagitis. Moreover, endoscopic evaluation may itself provide corroborative evidence that may contribute to the diagnosis of the motility disorder. Achalasia cardia may present with a wide spectrum of endoscopic findings from being entirely normal and the well-known and pathognomonic dilated sigmoid-shaped esophagus with food residue, to lesser-known ornate signs. The evidence on the role of endosonography in EMDs is conflicting and largely restricted to evaluation of pseudoachalasia. High-resolution manometry (HRM) remains the gold standard in the diagnosis of EMDs. Endoscopists must also keep abreast of the latest iteration of the Chicago classification version 4.0, which differs significantly from its predecessor in being more stringent in making diagnosis of esophagogastric junction outflow obstruction and disorders of peristalsis since these manometric findings may be seen in normal individuals and may be mimicked by opioid use and gastroesophageal reflux. The latest rendition also includes the use of provocative maneuvers and testing in both supine and sitting posture. Despite being the gold standard, there are certain lacunae in the use and interpretation of the Chicago classification of which the users should be well aware. Emerging technologies such as functional lumen imaging probe and planimetry, and timed barium esophagogram fill the lacuna in diagnosis of these motility disorders, which at times is beyond the resolution of HRM.","PeriodicalId":43098,"journal":{"name":"Journal of Digestive Endoscopy","volume":null,"pages":null},"PeriodicalIF":0.7,"publicationDate":"2021-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43832912","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
A 29-year-old man presented with shortness of breath associated with abdominal pain and distension of 2 weeks’ duration. He was diagnosed with alcohol-related acute necrotizing pancreatitis 4 months ago, and computed tomography (CT) done at 3 months of illness revealed a 2.5-cm collection in the neck of the pancreas with dilated upstream main pancreatic duct, suggesting a diagnosis of disconnected pancreatic duct. The investigations done during the current admission revealed hypoxia with amylase-rich exudative ascites (►Fig. 1A) and a large acute pseudocyst (AP) (►Fig. 1B). He underwent endoscopic ultrasound–guided transmural drainage of AP with a fully covered, self-expandable biflanged metal stent (BFMS) (►Fig. 1C). Post drainage, the patient had marked improvement in symptoms but developed palpable subcutaneous emphysema in the neck. CT chest revealed pneumomediastinum (►Fig. 2A; arrows) and CT abdomen revealedmarked reduction in the size of AP, resolution of ascites, and pneumoperitoneum (►Fig. 2B; arrows) along with pneumoretroperitoneum. The patient was treated with intravenous antibiotics, oxygen supplementation, and nasojejunal enteral feeding. The subcutaneous emphysema, tachypnea, and acute lung injury resolved in the following 72hours. Oral feeding was started 7 days later and the BFMSwas replacedwith two 7-Fr double pigtail stents 12 days post drainage. Thereafter, the patient was discharged and is currently asymptomatic.
{"title":"Pneumomediastinum after Endoscopic Transmural Drainage of an Acute Pseudocyst: Not All That Scary!","authors":"S. Rana, Mandeep Kang, Nikhil Bush, Rajesh Gupta","doi":"10.1055/s-0041-1741065","DOIUrl":"https://doi.org/10.1055/s-0041-1741065","url":null,"abstract":"A 29-year-old man presented with shortness of breath associated with abdominal pain and distension of 2 weeks’ duration. He was diagnosed with alcohol-related acute necrotizing pancreatitis 4 months ago, and computed tomography (CT) done at 3 months of illness revealed a 2.5-cm collection in the neck of the pancreas with dilated upstream main pancreatic duct, suggesting a diagnosis of disconnected pancreatic duct. The investigations done during the current admission revealed hypoxia with amylase-rich exudative ascites (►Fig. 1A) and a large acute pseudocyst (AP) (►Fig. 1B). He underwent endoscopic ultrasound–guided transmural drainage of AP with a fully covered, self-expandable biflanged metal stent (BFMS) (►Fig. 1C). Post drainage, the patient had marked improvement in symptoms but developed palpable subcutaneous emphysema in the neck. CT chest revealed pneumomediastinum (►Fig. 2A; arrows) and CT abdomen revealedmarked reduction in the size of AP, resolution of ascites, and pneumoperitoneum (►Fig. 2B; arrows) along with pneumoretroperitoneum. The patient was treated with intravenous antibiotics, oxygen supplementation, and nasojejunal enteral feeding. The subcutaneous emphysema, tachypnea, and acute lung injury resolved in the following 72hours. Oral feeding was started 7 days later and the BFMSwas replacedwith two 7-Fr double pigtail stents 12 days post drainage. Thereafter, the patient was discharged and is currently asymptomatic.","PeriodicalId":43098,"journal":{"name":"Journal of Digestive Endoscopy","volume":null,"pages":null},"PeriodicalIF":0.7,"publicationDate":"2021-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48669624","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
A. Maydeo, Shivaji Thakare, Amol Vadgaonkar, G. Patil, A. Dalal, N. Kamat, Sehajad Vora
Background Patients with gastrointestinal (GI) symptoms in remote areas do not have access to standard medical care with the issues related to cost of medical care, transportation, health literacy, lack of healthcare insurance—all preventing healthcare access in a timely manner. To overcome this, we designed a mobile endoscopy van with the intent to provide free essential medical services to the rural population. Methods This is a retrospective study of patients with predominantly upper GI symptoms at two community health centers (each 2 days camp). This is an audit of endoscopy findings in a community set up using a Mobile Endoscopy Unit (MEU). Patients' details were collected in a pre-designed questionnaire. Only those patients with alarm symptoms and suspicion of any pathological state underwent esophagogastroduodenoscopy (EGD) in MEU. Data analysis was done using descriptive statistics. Results A total of 724 patients (424 [58.5%] males; mean [SD] age 48.5 [5.2] years) were included. The commonest presenting symptom was heartburn in 377 (52.1%) patients. The median duration of symptoms was 6.5 (range: 2–36) months. Gastroesophageal reflux disease was seen in 16 (6.8%) patients, ulceroproliferative growth was noted in the stomach in 3 (1.3%) patients. Eighteen (7.6%) patients had a positive rapid urease test and received Helicobacter pylori eradication therapy. The most commonly prescribed drugs were proton-pump inhibitors in 692 (95.6%) patients. Nine (1.2%) patients had chronic liver disease secondary to alcoholism and were counseled for abstinence. All procedures were safely performed without any immediate adverse events. Conclusions Community outreach strategies such as the use of mobile endoscopy unit were found to be very useful in the diagnosis of GI symptoms. More research is needed in low-income countries to treat complex pathological states in rural patients.
{"title":"Impact of Mobile Endoscopy Unit for Rendering Gastrointestinal Endoscopy Services at Two Community Health Centers in Western India","authors":"A. Maydeo, Shivaji Thakare, Amol Vadgaonkar, G. Patil, A. Dalal, N. Kamat, Sehajad Vora","doi":"10.1055/s-0041-1741387","DOIUrl":"https://doi.org/10.1055/s-0041-1741387","url":null,"abstract":"\u0000 Background Patients with gastrointestinal (GI) symptoms in remote areas do not have access to standard medical care with the issues related to cost of medical care, transportation, health literacy, lack of healthcare insurance—all preventing healthcare access in a timely manner. To overcome this, we designed a mobile endoscopy van with the intent to provide free essential medical services to the rural population.\u0000 Methods This is a retrospective study of patients with predominantly upper GI symptoms at two community health centers (each 2 days camp). This is an audit of endoscopy findings in a community set up using a Mobile Endoscopy Unit (MEU). Patients' details were collected in a pre-designed questionnaire. Only those patients with alarm symptoms and suspicion of any pathological state underwent esophagogastroduodenoscopy (EGD) in MEU. Data analysis was done using descriptive statistics.\u0000 Results A total of 724 patients (424 [58.5%] males; mean [SD] age 48.5 [5.2] years) were included. The commonest presenting symptom was heartburn in 377 (52.1%) patients. The median duration of symptoms was 6.5 (range: 2–36) months. Gastroesophageal reflux disease was seen in 16 (6.8%) patients, ulceroproliferative growth was noted in the stomach in 3 (1.3%) patients. Eighteen (7.6%) patients had a positive rapid urease test and received Helicobacter pylori eradication therapy. The most commonly prescribed drugs were proton-pump inhibitors in 692 (95.6%) patients. Nine (1.2%) patients had chronic liver disease secondary to alcoholism and were counseled for abstinence. All procedures were safely performed without any immediate adverse events.\u0000 Conclusions Community outreach strategies such as the use of mobile endoscopy unit were found to be very useful in the diagnosis of GI symptoms. More research is needed in low-income countries to treat complex pathological states in rural patients.","PeriodicalId":43098,"journal":{"name":"Journal of Digestive Endoscopy","volume":null,"pages":null},"PeriodicalIF":0.7,"publicationDate":"2021-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45736781","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Anushka Verma, Muppa Indrakeela Girish, A. Dahale, Ashok Dalal, S. Sachdeva
Cytomegalovirus (CMV) colitis is a common occurrence in immunocompromised patients but uncommon in immunocompetent patients with usually mild and self-limiting symptoms and rarely gives rise to serious complications. 1 Gastrointestinalinvolvementisveryrareinimmunocompetent individuals; however, the commonly involved sites are colon and rectum. 2 We aimed to share our experience of CMVcolitis in immunocompetent patients. We are sharing our experience of four patients having immunocompetent status. Our aimwas to analyzeclinicoepidemiological-associated attributes ofCMV colitis in immunocompetent individuals. The of the abdominal diarrhea. hypertension coronavirus
{"title":"CMV Colitis in Immunocompetent Patients—A Case Series","authors":"Anushka Verma, Muppa Indrakeela Girish, A. Dahale, Ashok Dalal, S. Sachdeva","doi":"10.1055/s-0041-1742134","DOIUrl":"https://doi.org/10.1055/s-0041-1742134","url":null,"abstract":"Cytomegalovirus (CMV) colitis is a common occurrence in immunocompromised patients but uncommon in immunocompetent patients with usually mild and self-limiting symptoms and rarely gives rise to serious complications. 1 Gastrointestinalinvolvementisveryrareinimmunocompetent individuals; however, the commonly involved sites are colon and rectum. 2 We aimed to share our experience of CMVcolitis in immunocompetent patients. We are sharing our experience of four patients having immunocompetent status. Our aimwas to analyzeclinicoepidemiological-associated attributes ofCMV colitis in immunocompetent individuals. The of the abdominal diarrhea. hypertension coronavirus","PeriodicalId":43098,"journal":{"name":"Journal of Digestive Endoscopy","volume":null,"pages":null},"PeriodicalIF":0.7,"publicationDate":"2021-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46026177","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
A. Gawande, S. Mukewar, R. Daswani, Bhushan Bhaware, Saurabh S. Mukewar
The field of endoscopic ultrasound (EUS) has evolved significantly over the last two decades from being a tool of only diagnostic purpose to tissue acquisition and now therapeutic potential. There have been several important publications in the field of EUS in the last few years, which had a major impact in the clinical management of various gastrointestinal disorders. In this review, we discuss four such articles that in our opinion will significantly impact the role of EUS in treating various conditions. The first article is a randomized controlled trial comparing EUS-guided gall bladder drainage with percutaneous gall bladder drainage for high-risk acute cholecystitis. The second article is a randomized controlled trial comparing EUS versus minimally invasive surgery for necrotizing pancreatitis. The third article is a novel human study of EUS-guided portal pressure measurement in patients with portal hypertension. The last article is also a randomized controlled trial evaluating the role of rapid on-site evaluation for EUS-guided fine needle biopsy in solid pancreatic lesions.
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