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Harish Darak 2 Articles
Outcomes of thin versus thick-wire snares for cold snare polypectomy: a systematic review and meta-analysis
Suprabhat Giri, Vaneet Jearth, Harish Darak, Sridhar Sundaram
Clin Endosc 2022;55(6):742-750.   Published online November 9, 2022
AbstractAbstract PDFSupplementary MaterialPubReaderePub
/Aims: Cold snare polypectomy (CSP) is commonly used for the resection of colorectal polyps ≤10 mm. Data regarding the influence of snare type on CSP effectiveness are conflicting. Hence, this meta-analysis aimed to compare the outcomes and safety of thin- and thick-wire snares for CSP.
A comprehensive search of the literature published between 2000 and 2021 was performed of various databases for comparative studies evaluating the outcomes of thin- versus thick-wire snares for CSP.
Five studies with data on 1,425 polyps were included in the analysis. The thick-wire snare was comparable to the thin-wire snare with respect to complete histological resection (risk ratio [RR], 1.03; 95% confidence interval [CI], 0.97–1.09), overall bleeding (RR, 0.98; 95% CI, 0.40–2.40), polyp retrieval (RR, 1.01; 95% CI, 0.97–1.04), and involvement of submucosa in the resection specimen (RR, 1.28; 95% CI, 0.72–2.28). There was no publication bias and a small study effect, and the relative effects remained the same in the sensitivity analysis.
CSP using a thin-wire snare has no additional benefit over thick-wire snares in small colorectal polyps. Factors other than snare design may play a role in improving CSP outcomes.


Citations to this article as recorded by  
  • Factors determining the resection ability of snares in cold snare polypectomy: Construction of an ex vivo model for accurately evaluating resection ability
    Ryohei Hirose, Takuma Yoshida, Naohisa Yoshida, Katsuma Yamauchi, Hajime Miyazaki, Naoto Watanabe, Risa Bandou, Ken Inoue, Hiroshi Ikegaya, Takaaki Nakaya, Yoshito Itoh
    Digestive Endoscopy.2024; 36(5): 573.     CrossRef
  • Effectiveness and safety of thin vs. thick cold snare polypectomy of small colorectal polyps: Systematic review and meta-analysis
    Rishad Khan, Sunil Samnani, Marcus Vaska, Samir C Grover, Catharine M Walsh, Jeffrey Mosko, Michael Bourke, Steven J Heitman, Nauzer Forbes
    Endoscopy International Open.2024; 12(01): E99.     CrossRef
  • International Digestive Endoscopy Network consensus on the management of antithrombotic agents in patients undergoing gastrointestinal endoscopy
    Seung Joo Kang, Chung Hyun Tae, Chang Seok Bang, Cheol Min Shin, Young-Hoon Jeong, Miyoung Choi, Joo Ha Hwang, Yutaka Saito, Philip Wai Yan Chiu, Rungsun Rerknimitr, Christopher Khor, Vu Van Khien, Kee Don Choi, Ki-Nam Shim, Geun Am Song, Oh Young Lee
    Clinical Endoscopy.2024; 57(2): 141.     CrossRef
  • IDEN Consensus on Management of Antithrombotic Agents in Patients Undergoing Gastrointestinal Endoscopy
    Seung Joo Kang, Chung Hyun Tae, Chang Seok Bang, Cheol Min Shin, Young-Hoon Jeong, Miyoung Choi, Joo Ha Hwang, Yutaka Saito, Philip Wai Yan Chiu, Rungsun Rerknimitr, Christopher Khor, Vu Van Khien, Kee Don Choi, Ki-Nam Shim, Geun Am Song, Oh Young Lee
    The Korean Journal of Gastroenterology.2024; 83(6): 217.     CrossRef
  • Does the wire diameter really determine the outcomes in cold snare polypectomy?
    S Giri, S Sundaram
    Journal of Gastroenterology and Hepatology.2023; 38(4): 665.     CrossRef
  • Cold resection for colorectal polyps: where we are and where we are going?
    Antonio Capogreco, Ludovico Alfarone, Davide Massimi, Alessandro Repici
    Expert Review of Gastroenterology & Hepatology.2023; 17(7): 719.     CrossRef
  • Endoscopic treatment of colorectal polyps and early colorectal cancer
    Yunho Jung
    Journal of the Korean Medical Association.2023; 66(11): 642.     CrossRef
  • 2,671 View
  • 160 Download
  • 6 Web of Science
  • 7 Crossref
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Outcomes of Endoscopic Management among Patients with Bile Leak of Various Etiologies at a Tertiary Care Center
Suprabhat Giri, Sridhar Sundaram, Harish Darak, Sanjay Kumar, Shobna Bhatia
Clin Endosc 2020;53(6):727-734.   Published online August 21, 2020
AbstractAbstract PDFPubReaderePub
/Aims: Bile leak is a common complication of cholecystectomy, and it is also observed in other conditions such as ruptured liver abscess, hydatid cyst, and trauma. Endoscopic retrograde cholangiopancreatography (ERCP) is the first-line management for such conditions. However, studies on the outcomes of endoscopic management for bile leaks with etiologies other than post-cholecystectomy injury are extremely limited.
We conducted a retrospective review of patients with symptomatic bile leak who were referred to a tertiary care center and who underwent ERCP between April 2016 and April 2019. The primary outcome was complete symptomatic resolution without extravasation of the contrast medium during the second ERCP conducted after 6 weeks.
In total, 71 patients presented with symptomatic bile leak. The etiologies of bile leak were post-cholecystectomy injury in 34 (47.8%), liver abscess in 20 (28.1%), and post-hydatid cyst surgery in 11 (15.4%) patients. All patients were managed with ERCP, sphincterotomy, and stent placement for 6 weeks, except for one who underwent surgery. The primary outcome was achieved in 65 (91.5%) of 71 patients. There was no significant difference in terms of outcome in relation to the interval between the diagnosis of bile leak and ERCP.
Most patients with bile leak can be successfully managed with ERCP even when performed on an elective basis.


Citations to this article as recorded by  
  • A critical appraisal of the ISGLS definition of biliary leakage after liver resection
    Svenja Sliwinski, Jan Heil, Josephine Franz, Hanan El Youzouri, Michael Heise, Wolf O. Bechstein, Andreas A. Schnitzbauer
    Langenbeck's Archives of Surgery.2023;[Epub]     CrossRef
  • Progress in ERCP Treatment of Biliary Complications in Patients with Hepatic Echinococcosis
    燕泽 林
    Advances in Clinical Medicine.2023; 13(03): 4013.     CrossRef
  • Diagnosis and management of bile leaks after severe liver injury: A Trauma Association of Canada multicenter study
    Morgan Schellenberg, Chad G. Ball, Natthida Owattanapanich, Brent Emigh, Patrick B. Murphy, Bradley Moffat, Brett Mador, Andrew Beckett, Jennie Lee, Emilie Joos, Samuel Minor, Matt Strickland, Kenji Inaba
    Journal of Trauma and Acute Care Surgery.2022; 93(6): 813.     CrossRef
  • Postoperative bile leakage caused by intrahepatic duct injury during right hemicolectomy
    Jaram Lee, Ook Song, Hyeong-Min Park, Soo Young Lee, Chang Hyun Kim, Hyeong Rok Kim
    Medicine.2021; 100(46): e27877.     CrossRef
  • The Need for a Better-Designed Study of the Outcomes of Endoscopic Management of Bile Leak
    Hyung Ku Chon, Eun Ji Shin, Seong-Hun Kim
    Clinical Endoscopy.2020; 53(6): 633.     CrossRef
  • 4,599 View
  • 117 Download
  • 4 Web of Science
  • 5 Crossref
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