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   Table of Contents - Current issue
October-December 2021
Volume 1 | Issue 4
Page Nos. 135-188

Online since Friday, September 24, 2021

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Ancillary techniques and maneuvers in high resolution esophageal manometry p. 135
Mayank Jain, Melpakkam Srinivas, Venkataraman Jayanthi
High-resolution esophageal manometry (HREM) is a technique to determine the function of esophageal musculature and integrity of esophagogastric junction. Conventionally, the HREM study is done in the supine position using ten swallows of 5 ml water each. Apart from this mandatory testing, ancillary testing and maneuvers are undertaken to elicit detailed physiological information. These include multiple rapid swallows, rapid drink tests, testing in the upright position with solid swallows, and pharmacological testing. The present review highlights these techniques and their clinical utility.
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Managing patients with inflammatory bowel disease during the COVID-19 pandemic p. 139
Balakrishnan S Ramakrishna
The coronavirus disease 2019 pandemic has paralyzed the world now for 20 months. SARS-CoV-2 infection appears to result in a number of inflammatory, thrombogenic, and immune events in susceptible individuals. Patients with inflammatory bowel disease (IBD) are on chronic immunosuppressive medication. Furthermore, they have relapses of disease that requires intensification of their immunosuppressive treatment. Our understanding of the management of such patients during a viral pandemic has significantly improved due to the scientific exchanges that have taken place, through print publication and virtual sharing of experiences among IBD caregivers. This brief review provides an overview of the basic immunology of SARS-CoV-2 infection, how it impacts patients with IBD and current guidelines on managing therapy for IBD patients during a pandemic.
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Dynamic scoring of appetite predicts inpatient survival in patients with acute-on-chronic liver failure p. 143
Rajeeb Jaleel, Anand Sharma, Vimala Selvaraj, Rekha Aaron, Jayaprakash Muliyil, Balakrishnan Vijayalekshmi, Kunnisery Ananthsubramanian Balasubramanian, Balavendra Antonisamy, Ashish Goel, Uday George Zachariah, Chundamannil Eapen Eapen
Background and Aim: Decreased appetite is common in patients with liver disease and may be mediated by inflammatory cytokines. Acute-on-chronic liver failure (ACLF) is associated with raised inflammatory cytokines. The aim of this study was to evaluate appetite scoring as a predictor of inhospital survival in patients with ACLF. Methods: In a prospective observational study, consecutive hospitalized patients with ACLF were recruited. Appetite was assessed daily using Simplified Nutritional Appetite Questionnaire (SNAQ). The total SNAQ score ranged from 4 to 20, and a change in SNAQ score ≥1 was considered significant. Patients received standard medical care. Outcome was defined as good when patient was discharged in a stable condition and as poor if patient died or was discharged in terminal state. Results: Seventy-five ACLF patients (mean age 44 years; 66 males) were recruited. The median length of hospital stay was 5 (range: 1–20) days. Outcome was good in 50 and poor in 25 patients. Patients with good outcome had higher Day 1 SNAQ score (median: 12, range: 7–16) than patients with poor outcome (median: 10, range: 5–16) (P < 0.001). The area under receiver operating characteristic curve to predict poor outcome was 0.71 (95% confidence interval [CI]: 0.56–0.86) for Day 1 SNAQ score and 0.90 (95% CI: 0.82–0.98) for SNAQ δ. When divided into tertiles based on Day 1 SNAQ score, the outcome was good for all patients whose appetite improved and poor for all patients whose appetite worsened on Day 3. Conclusion: Appetite (SNAQ) scores on Day 1 and change on Day 3 predict inhospital survival in ACLF patients. SNAQ is a simple bedside tool which may help in guiding therapeutic decisions in ACLF patients. Further larger studies are required to validate these findings.
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Salvaging migrated lumen apposing metal stent during necrosectomy for walled off pancreatic necrosis in disconnected pancreatic duct syndrome p. 148
Shankar Zanwar, Shailesh Chawhare, Akshay Thorat
Migration of the lumen apposing stent can be a routine problem during stent placement or necrosectomy and can be a significant source of apprehension for the performing endoscopist. We present our case of walled off necrosis with disconnected pancreatic duct syndrome where the stent migrated during the necrosectomy and was salvaged by replacement. This can be a useful piece of information for endoscopist working in limited resource setting where inserting a new stent could be cost inefficient.
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Dual or single risk factor in acute liver failure p. 151
Bhargav Yugandar Varanasi, Chandan Kumar Kedarishetty, Karthikeyan Mu, Thamarai S Selvan, Jayanthi Venkataraman
Acute liver failure (ALF) is a medical emergency. We report a case of ALF due to paracetamol overdose in a patient with pregnancy-related transient hepatic venous outflow obstruction, managed conservatively. The patient made a complete recovery 6 months later.
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Pseudomembranous colitis due to Cytomegalovirus infection during SARS COVID-19 convalescence p. 155
Rohan Yewale, Banumathi Ramakrishna, Naveen Chand, Balakrishnan S Ramakrishna
Pseudomembranous colitis (PMC) is a well-known entity with an increasing prevalence in the current post antibiotic era. Its endoscopic and histological morphology is often considered synonymous with Clostridioides difficile-associated colitis. Cytomegalovirus (CMV) infection is a less commonly reported cause of PMC. We report an interesting case of a 61-year-old gentleman with an acute-onset, inflammatory diarrhea during SARS COVID-19 convalescence who was found to have features consistent with PMC on colonoscopy. However, histological and immunohistochemistry analysis of colonic biopsies revealed the presence of CMV infection in the absence of C. difficile toxins on stool assay.
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Cryptogenic multifocal ulcerous stenosing enteritis p. 159
Doraiswami Babu Vinish, Partheeban Balasundaram, Banumathi Ramakrishna, Alagu Balaji Palaniappan, Arulprakash Sarangapani, Balakrishna Siddhartha Ramakrishna
Crytpogenic multifocal ulcerous setnosing enteritis is an unusual cause of gastrointestinal bleed. The objective of this report is to highlight small bowel ulcerations as a cause of anemia and the role of wireless capsule endoscopy in the diagnosis of CMUSE. We present here two young women who had been evaluated for anemia with normal gastroscopy, colonoscopy and contrast CT's and requiring multiple blood transfusions over the years. Both patients had wireless capsule endoscopy which showed multiple ulcerations with stenosis in the small intestine, resulting in capsule retention in the small intestine which was retrieved. Both patients improved with steroids and azathioprine. To summarize CMUSE could be cause of obscure GI bleed, when CMUSE is a consideration as the cause of GI bleed wireless capsule endoscopy should be used in caution.
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Pancreatic pseudocyst with Candida glabrata infection p. 164
Dinu Abirami Premkumar, Joy Varghese
The incidence of infection in pancreatic pseudocysts is estimated to be about 8.5%, commonly being bacterial. Fungal infection may occur and is usually secondary to intervention. We report here the case of a 51-year-old male with pancreatitis – not previously subjected to endoscopic, radiological, or surgical intervention – who presented with fever and mass and was found to have a pancreatic pseudocyst with Candida glabrata infection.
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Endoscopic management of failed surgical repair of Boerhaave's syndrome p. 167
Shankar Zanwar, Vikas Gupta, Nirmal Patle, Ashish Ganjare, Anantsingh Rajput, Shailesh Chaware
We present a case of failed surgical repair of Boerhaave's syndrome managed with minimally invasive care and first of its kind use of Padlock Clip for Boerhaave's syndrome.
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Clinical and endoscopic characterization of patients with dyspepsia p. 170
Mayank Jain, Vinodini Agrawal
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Liver Sliver p. 173
Kayalvizhi Jayaraman, D Karthikeyan
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Postendoscopy bilateral parotid enlargement p. 174
Kartik Natarajan, Kushan Sengupta, VS Hemamala, Ubal Dhus
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Gastroenterology elsewhere p. 175
Kayalvizhi Jayaraman
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Abstracts of posters presented at TNISGCON March 2021 p. 177

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