Clinical Endoscopy

Shivaraj Afzalpurkar

3 Articles

Influence of biliary stents on the diagnostic outcome of endoscopic ultrasound–guided tissue acquisition from solid pancreatic lesions: a systematic review and meta-analysis: Suprabhat Giri, Shivaraj Afzalpurkar, Sumaswi Angadi, Jijo Varghese, Sridhar Sundaram; Clin Endosc 2023;56(2):169-179. Published online February 15, 2023; DOI: https://doi.org/10.5946/ce.2022.282

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Background
/Aims: This meta-analysis analyzed the effect of an indwelling biliary stent on endoscopic ultrasound (EUS)–guided tissue acquisition from pancreatic lesions.
Methods
A literature search was performed to identify studies published between 2000 and July 2022 comparing the diagnostic outcomes of EUS-TA in patients with or without biliary stents. For non-strict criteria, samples reported as malignant or suspicious for malignancy were included, whereas for strict criteria, only samples reported as malignant were included in the analysis.
Results
Nine studies were included in this analysis. The odds of an accurate diagnosis were significantly lower in patients with indwelling stents using both non-strict (odds ratio [OR], 0.68; 95% confidence interval [CI], 0.52–0.90) and strict criteria (OR, 0.58; 95% CI, 0.46–0.74). The pooled sensitivity with and without stents were similar (87% vs. 91%) using non-strict criteria. However, patients with stents had a lower pooled sensitivity (79% vs. 88%) when using strict criteria. The sample inadequacy rate was comparable between groups (OR, 1.12; 95% CI, 0.76–1.65). The diagnostic accuracy and sample inadequacy were comparable between plastic and metal biliary stents.
Conclusions
The presence of a biliary stent may negatively affect the diagnostic outcome of EUS-TA for pancreatic lesions.

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Role of Endoscopic Ultrasound in Diagnosis of Pancreatic Ductal Adenocarcinoma
Abhirup Chatterjee, Jimil Shah
Diagnostics.2023; 14(1): 78. CrossRef

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A prospective study of fully covered self-expandable metal stents for refractory benign pancreatic duct strictures: Bhavik Bharat Shah, Gajanan Ashokrao Rodge, Usha Goenka, Shivaraj Afzalpurkar, Mahesh Kumar Goenka; Clin Endosc 2022;55(6):793-800. Published online April 4, 2022; DOI: https://doi.org/10.5946/ce.2021.211

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Background
/Aims: Fully covered self-expanding metal stents (FCSEMSs) are a relatively novel option for treating painful main pancreatic duct refractory strictures in patients with chronic pancreatitis. Herein, we aimed to assess the efficacy, feasibility, and safety of FCSEMSs in this patient group.
Methods
This prospective single-center study included patients who underwent endoscopic retrograde pancreatography with FCSEMS placement. The primary endpoints were the technical and clinical success rates. A reduction in visual analog scale pain score of >50% compared with that before stent placement was defined as clinical success. Secondary endpoints were resolution of pancreatic strictures on fluoroscopy during endoscopic retrograde pancreatography and the development of stent-related adverse events.
Results
Thirty-six patients were included in the analysis. The technical success rate was 100% (n=36) and the clinical success rate was 86.1% (n=31). There was a significant increase in stricture diameter from 1.7 mm to 3.5 mm (p<0.001) after stent removal. The mean visual analog scale pain score showed statistically significant improvement. At 19 months of follow-up, 55.6% of the patients were asymptomatic. Stent migration (16.7%), intolerable abdominal pain (8.3%), development of de novo strictures (8.3%), and mild pancreatitis (2.8%) were the most common adverse events.
Conclusions
FCSEMS placement showed good technical and clinical success rates for achieving pain relief in patients with refractory main pancreatic duct strictures.

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Citric Acid Loaded Hydrogel-Coated Stent for Dissolving Pancreatic Duct Calculi
Jing Li, Yanwei Lv, Zheng Chen, Jiulong Zhao, Shige Wang
Gels.2024; 10(2): 125. CrossRef
Fully Covered Self-expandable Metallic Stents for Refractory Benign Pancreatic Duct Strictures: A Systematic Review and Meta-analysis
Gajanan Rodge, Suprabhat Giri, Kailash Kolhe, Shivaraj Afzalpurkar, Sidharth Harindranath, Sridhar Sundaram, Aditya Kale
Surgical Laparoscopy, Endoscopy & Percutaneous Techniques.2024; 34(5): 529. CrossRef
Self-expanding metallic stent for refractory pancreatic duct stricture in chronic pancreatitis: A prospective follow-up study
Praveer Rai, Pankaj Kumar, Ashok Kumar, Sana Asari, Kartik Agarwal, Mayank, Ravi V. Krishna Kishore, Prabhaker Mishra
Indian Journal of Gastroenterology.2023;[Epub] CrossRef
Quality of life after endoscopic procedures for chronic pancreatitis: A multicentre study
Mikael Parhiala, Camilla Nøjgaard, Andreas Bartholdy, Anne Waage, Povilas Ignatavičius, Trond Engjom, Georg Dimcevski, Ingrid Kvåle Nordaas, Evangelos Kalaitzakis, Asbjørn M. Drewes, Amer Hadi, Søren S. Olesen, Jakob L. Poulsen, Johanna Laukkarinen
United European Gastroenterology Journal.2023; 11(9): 884. CrossRef
Pancreatic duct stents
Jin Hui Yi, Zhao Shen Li, Liang Hao Hu
Journal of Digestive Diseases.2022; 23(12): 675. CrossRef

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Mucosal incision-assisted biopsy versus endoscopic ultrasound-assisted tissue acquisition for subepithelial lesions: a systematic review and meta-analysis: Suprabhat Giri, Shivaraj Afzalpurkar, Sumaswi Angadi, Sridhar Sundaram; Clin Endosc 2022;55(5):615-625. Published online August 4, 2022; DOI: https://doi.org/10.5946/ce.2022.133

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Background
/Aims: Mucosal incision-assisted biopsy (MIAB) for tissue acquisition (TA) from subepithelial lesions (SELs) is emerging as an alternative to endoscopic ultrasound (EUS)-guided TA. Only a limited number of studies compared the diagnostic utility of MIAB and EUS for upper gastrointestinal (GI) SELs; therefore, we conducted this systematic review and meta-analysis.
Methods
A comprehensive literature search from January 2020 to January 2022 was performed to compare the diagnostic accuracy and safety of MIAB and EUS-guided TA for upper GI SELs.
Results
Seven studies were included in this meta-analysis. The pooled technical success rate (risk ratio [RR], 0.96; 95% confidence interval [CI], 0.89–1.04) and procedural time (mean difference=–4.53 seconds; 95% CI, –22.38 to 13.31] were comparable between both the groups. The overall chance of obtaining a positive diagnostic yield was lower with EUS than with MIAB for all lesions (RR, 0.83; 95% CI, 0.71–0.98) but comparable when using a fine-needle biopsy needle (RR, 0.93; 95% CI, 0.83–1.04). The positive diagnostic yield of MIAB was higher for lesions <20 mm (RR, 0.75; 95% CI, 0.63–0.89). Six studies reported no adverse events.
Conclusions
MIAB can be considered an effective alternative to EUS-guided TA for upper GI SELs without an increased risk of adverse events.

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Technical outcomes and postprocedural courses of mucosal incision‐assisted biopsy for possible gastric gastrointestinal stromal tumors: A series of 48 cases (with video)
Eriko Koizumi, Osamu Goto, Shun Nakagome, Tsugumi Habu, Yumiko Ishikawa, Kumiko Kirita, Hiroto Noda, Kazutoshi Higuchi, Takeshi Onda, Teppei Akimoto, Jun Omori, Naohiko Akimoto, Katsuhiko Iwakiri
DEN Open.2024;[Epub] CrossRef
The Diagnostic Approach of Benign Esophageal Tumors: A Narrative Review
Alex R. Jones, Preksha Vankawala, Tarek Sawas
Current Treatment Options in Gastroenterology.2024; 22(2): 44. CrossRef
Unroofing of subepithelial lesions in the upper gastrointestinal tract using cold snare: an easy and efficient technique for diagnosis
Bernhard Morell, Frans Olivier The, Christoph Gubler, Fritz Ruprecht Murray
Clinical Endoscopy.2024; 57(2): 274. CrossRef
Diagnostic yield of endoscopic and EUS-guided biopsy techniques in subepithelial lesions of the upper GI tract: a systematic review
Cynthia A. Verloop, Jacqueline A.C. Goos, Marco J. Bruno, Rutger Quispel, Lydi M.J.W. van Driel, Lieke Hol
Gastrointestinal Endoscopy.2024; 99(6): 895. CrossRef
Small gastric subepithelial lesions: A sand in the eye
Tanyaporn Chantarojanasiri, Nikhil Sonthalia, Rashid N. Lui
Journal of Gastroenterology and Hepatology.2024; 39(7): 1207. CrossRef
EUS‐guided tissue acquisition from gastric subepithelial lesions—The optimal technique still remains undecided
Suprabhat Giri, Sridhar Sundaram
Australasian Journal of Ultrasound in Medicine.2024;[Epub] CrossRef
Diagnostic ability and adverse events of mucosal incision‐assisted biopsy for gastric subepithelial tumors: Systematic review and meta‐analysis
Eriko Koizumi, Osamu Goto, Akihisa Matsuda, Toshiaki Otsuka, Yumiko Ishikawa, Shun Nakagome, Masahiro Niikawa, Tsugumi Habu, Keiichiro Yoshikata, Kumiko Kirita, Hiroto Noda, Kazutoshi Higuchi, Takeshi Onda, Jun Omori, Naohiko Akimoto, Hiroshi Yoshida, Kat
Digestive Endoscopy.2024;[Epub] CrossRef
Approach to Small Gastric Subepithelial Lesions
Moon Won Lee, Bong Eun Lee
The Korean Journal of Helicobacter and Upper Gastrointestinal Research.2023; 23(1): 28. CrossRef
Is the canalization to obtain deep biopsy of gastrointestinal subepithelial tumors miniprobe-guidded as an alternative to conventional known techniques?
Modesto Varas Lorenzo, Ramón Abad Belando
Revista Española de Enfermedades Digestivas.2023;[Epub] CrossRef
Role of Advanced Gastrointestinal Endoscopy in the Comprehensive Management of Neuroendocrine Neoplasms
Harishankar Gopakumar, Vinay Jahagirdar, Jagadish Koyi, Dushyant Singh Dahiya, Hemant Goyal, Neil R. Sharma, Abhilash Perisetti
Cancers.2023; 15(16): 4175. CrossRef

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