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Extracorporeal shock wave lithotripsy for pancreatic and large common bile duct stones

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World Journal of Gastroenterology 2011年第39期17卷 4365-4371页

作者： Manu Tandan d nageshwar reddy reddy Asian Institute of Gastroenterology 6-3-652 SomajigudaHyderabad 500 082India

Extraction of large pancreatic and common bile duct(CBd)calculi has always challenged the therapeutic endoscopist.Extracorporeal shockwave lithotripsy(ESWL)is an excellent tool for patients with large pancreatic and CBd calculi that are not amenable to routine endotherapy.Pancreatic calculi in the head and body are targeted by ESWL,with an aim to fragment them todiameter so that they can be extracted by subsequent endoscopic retrograde cholangio-pancreatography(ERCP).In our experience,complete clearance of the pancreatic duct was achieved in 76% and partial clearance in 17%of 1006 patients.Short-term pain relief with reduction in the number of analgesics ingested was seen in 84%of these patients.For large CBd calculi,a nasobiliary tube is placed to help target the calculi,as well as bathe the calculi in salinea simple maneuver which helps to facilitate fragmenta-tion.The aim is to fragment calculi tod clear the same during ERCP.Complete clearance of the CBd was achieved in 84.4%of and partial clearance in 12.3%of 283 patients.More than 90%of the patients with pancreatic and biliary calculi needed three or fewer sessions of ESWL with 5000 shocks being de-livered at each session.The use of epidural anesthesia helped in reducing patient movement.This,together with the better focus achieved with newer third-gen-eration lithotripters,prevents collateral tissue damage and minimizes the complications.Complications in our experience with nearly 1300 patients were minimal,and no extension of hospital stay was required.Similar rates of clearance of pancreatic and biliary calculi with minimal adverse effects have been reported from the centers where ESWL is performed regularly.In view of its high efficiency,non-invasive nature and low complication rates,ESWL can be offered as the first-line therapy for selected patients with large pancreatic and CBd calculi.

关键词：体外震波碎石胆总管结石体外冲击波胰腺癌生物多样性公约硬膜外麻醉并发症清除率

Endoscopic management of pancreatic fluid collectionsrevisited

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World Journal of Gastroenterology 2017年第15期23卷 2660-2672页

作者： Zaheer Nabi Jahangeer Basha d nageshwar reddy department of Gastroenterology Asian Institute of Gastro-enterology

The development of pancreatic fluid collections(PFC) is one of the most common complications of acute severe pancreatitis. Most of the acute pancreatic fluid collections resolve and do not require endoscopic drainage. However, a substantial proportion of acute necrotic collections get walled off and may require drainage. Endoscopic drainage of PFC is now the preferred mode of drainage due to reduced morbidity and mortality as compared to surgical or percutaneous drainage. With the introduction of new metal stents, the efficiency of endoscopic drainage has improved and the task of direct endoscopic necrosectomy has be-come easier. The requirement of re-intervention is less with new metal stents as compared to plastic stents. However, endoscopic drainage is not free of adverse events. Severe complications including bleeding, perforation, sepsis and embolism have been described with endoscopic approach to PFC. Therefore, the endoscopic management of PFC is a multidisciplinary affair and involves interventional radiologists as well as GI surgeons to deal with unplanned adverse events and failures. In this review we discuss the recent advances and controversies in the endoscopic management of PFC.

关键词： Endotherapy Pseudocyst 胰腺的坏死 Necrosectomy

Genetic mechanisms underlying the pathogenesis of tropical calcific pancreatitis

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World Journal of Gastroenterology 2009年第3期15卷 264-269页

作者： Swapna Mahurkar d nageshwar reddy G Venkat Rao Giriraj Ratan Chandak Asian Institute of Gastroenterology 6-3-661SomajigudaHyderabad 500082India Genome Research Group Centre for Cellular and Molecular BiologyUppal RoadHyderabad 500007India

Chronic pancreatitis is known to be a heterogeneous disease with varied etiologies.Tropical calcific pancreatitis(TCP) is a severe form of chronic pancreatitis unique to developing countries.With growing evidence of genetic factors contributing to the pathogenesis of TCP,this review is aimed at compiling the available information in this field.We also propose a two hit model to explain the sequence of events in the pathogenesis of TCP.

关键词：慢性胰腺炎钙化胰腺炎胰腺糖尿病综合疾病

The outcomes and safety of patients undergoing endoscopic retrograde cholangiopancreatography combining a single-use cholangioscope and a single-use duodenoscope:A multicenter retrospective international study

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Hepatobiliary & Pancreatic diseases International 2024年第1期23卷 71-76页

作者： Alessandro Fugazza Matteo Colombo Michel Kahaleh V.Raman Muthusamy Bick Benjamin Wim Laleman Carmelo Barbera Carlo Fabbri Jose Nieto Abed Al-Lehibi Mohan Ramchandani Amy Tyberg Haroon Shahid Avik Sarkar dean Ehrlich Stuart Shermand Cecilia Binda Marco Spadaccini Andrea Iannone Kareem Khalaf nageshwar reddy Andrea Anderloni Alessandro Repici division of Gastroenterology and digestive Endoscopy Humanitas Research Hospital-IRCCSVia Manzoni 5620089RozzanoMilanoItaly Gastroenterology Rutgers Robert Wood JohnsonNew BrunswickNew JerseyUSA Vatche and Tamar Manoukian division of digestive diseases University of CaliforniaLos Angeles School of Medicine at UCLALos AngelesCaliforniaUSA division of digestive and Liver disorders Indiana University School of MedicineIndianapolisINUSA department of Gastroenterology and Hepatology University Hospitals LeuvenKU Leuven3000 LeuvenBelgium U.O.C.di Gastroenterologia ed Endoscopia digestiva Ospedale Giuseppe MazziniASL TeramoItaly Gastroenterology and digestive Endoscopy Unit Forlì-Cesena HospitalsAUSL RomagnaForlì-CesenaItaly Borland Groover Clinic JacksonvilleFloridaUSA department of Gastroenterology and Hepatology King Fahad Medical CityRiyadhSaudi Arabia Asian Institute of Gastroenterology HyderabadIndia Section of Gastroenterology Department of Emergency and Organ TransplantationUniversity of BariBari 70124Italy department of Biomedical Sciences Humanitas UniversityVia Rita Levi Montalcini 420090Pieve EmanueleMilanItaly

Background: duodenoscope-related multidrug-resistant organism(MdRO) infections raise concerns. disposable duodenoscopes have been recently introduced in the market and approved by regulatory agencies with the aim to reduce the risk of endoscopic retrograde cholangiopancreatography(ERCP) associated infections. The aim of this study was to evaluate the outcome of procedures performed with single-use duodenoscopes in patients with clinical indications to single-operator cholangiopancreatoscopy. Methods: This is a multicenter international, retrospective study combining all patients who underwent complex biliopancreatic interventions using the combination of a single-use duodenoscope and a single-use cholangioscope. The primary outcome was technical success defined as ERCP completion for the intended clinical indication. Secondary outcomes were procedural duration, rate of cross-over to reusable duodenoscope, operator-reported satisfaction score(1 to 10) on performance rating of the single-use duodenoscope, and adverse event(AE) rate. Results: A total of 66 patients(26, 39.4% female) were included in the study. ERCP was categorized according to ASGE ERCP grading system as 47(71.2%) grade 3 and 19(28.8%) grade 4. The technical success rate was 98.5%(65/66). Procedural duration was 64(interquartile range 15-189) min, cross-over rate to reusable duodenoscope was 1/66(1.5%). The satisfaction score of the single-use duodenoscope classified by the operators was 8.6 ± 1.3 points. Four patients(6.1%) experienced AEs not directly related to the single-use duodenoscope, namely 2 post-ERCP pancreatitis(PEP), 1 cholangitis and 1 bleeding.Conclusions: Single-use duodenoscope is effective, reliable and safe even in technically challenging procedures with a non-inferiority to reusable duodenoscope, making these devices a viable alternative to standard reusable equipment.

关键词： Single-operator cholangioscopy Single-use duodenoscope Endoscopic retrograde cholangiopancreatography Indeterminate biliary stricture difficult biliary stones

Vitamin d, selenium in type 2 diabetes and Hashimoto's thyroiditis: Is it effective?

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World Journal of diabetes 2024年第5期15卷 1048-1050页

作者： Kotha Sugunakar reddy Vishakha Jain Sakthivadivel Varatharajan Janardhana reddy Pallavali department of General Medicine All India Institute of Medical SciencesTelanganaHyderabad 508126India

The study by Feng et al,explores treatment approaches for these coexisting conditions.It emphasizes the potential advantages of selenium and vitamin d supplementation but also raises methodological and patient selection concerns.Findings indicate a complex interplay between interventions and disease markers,prompting the need for further research.despite limitations,the study offers valuable insights into managing the intricate relationship between type 2 diabetes mellitus and Hashimoto's thyroiditis.The authors'contributions shed light on potential treatment avenues,although careful consideration of study design and patient characteristics is warranted for future investigations in this domain.

关键词： Vitamin d Selenium Type 2 diabetes Mellitus Hashimoto’s thyroiditis

drugs for Non-alcoholic Steatohepatitis (NASH): Quest for the Holy Grail

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Journal of Clinical and Translational Hepatology 2021年第1期9卷 40-50页

作者： Mithun Sharma Madhumita Premkumar Anand V Kulkarni Pramod Kumar d nageshwar reddy Nagaraja Padaki Rao department of Hepatology Asian Institute of GastroenterologyHyderabadIndia department of Hepatology PGIMERChandigarhIndia department of Gastroenterology Asian Institute of GastroenterologyHyderabadIndia

Nonalcoholic fatty liver disease (NAFLd) is a global epidemic that is likely to become the most common cause of chronic liver disease in the next decade, worldwide. Though numerous drugs have been evaluated in clinical trials, most of them have returned inconclusive results and shown poorly-tolerated adverse effects. None of the drugs have been approved by the Food and drug Administration for treating biopsy-proven non-alcoholic steatohepatitis (NASH). Vitamin E and pioglitazone have been extensively used in treatment of biopsy-proven nondiabetic NASH patients. Although some amelioration of inflammation has been seen, these drugs did not improve the fibrosis component of NASH. Therefore, dietary modification and weight reduction have remained the cornerstone of treatment of NASH;moreover, they have shown to improve histological activity as well as fibrosis. The search for an ideal drug or ‘Holy Grail’ within this landscape of possible agents continues, as weight reduction is achieved only in less than 10% of patients. In this current review, we summarize the drugs for NASH which are under investigation, and we provide a critical analysis of their up-to-date results and outcomes.

关键词： Fatty liver NAFLd NASH Obeticholic acid Saroglitazar

Pathophysiology and Prevention of Paracentesis-induced Circulatory dysfunction:A Concise Review

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Journal of Clinical and Translational Hepatology 2020年第1期8卷 42-48页

作者： Anand V Kulkarni Pramod Kumar Mithun Sharma T R Sowmya Rupjyoti Talukdar Padaki Nagaraj Rao d nageshwar reddy department of Hepatology Asian Institute of GastroenterologyHyderabadIndia department of Gastroenterology Asian Institute of GastroenterologyHyderabadIndia

Annually,10%of cirrhotic patients with ascites develop refractory ascites for which large-volume paracentesis(LVP)is a frequently used therapeutic procedure.LVP,although a safe method,is associated with circulatory dysfunction in a significant percentage of patients,which is termed para-centesis-induced circulatory dysfunction(PICd).PICd results in faster reaccumulation of ascites,hyponatremia,renal impairment,and shorter survival.PICd is diagnosed through laboratory results,with increases of>50%of baseline plasma renin activity to a value≥4 ng/mL/h on the fifth to sixth day after paracentesis.In this review,we discuss the pathophysi-ology and prevention of PICd.

关键词： Refractory ascites Plasma renin activity Large-volume paracentesis Cirrhosis Portal hypertension

dietary Green Tea Extract and Antioxidants Improve Insulin Secretory Functions of Pancreatic β-Cells in Mild and Severe Experimental Rodent Model of Chronic Pancreatitis

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Open Journal of Endocrine and Metabolic diseases 2024年第2期14卷 53-72页

作者： Galande Sheethal Ranjeet K. Tokala Pavan Pondugala Krishna Vemula Vijayalakshmi Venkatesan Pothani Suresh Surya Satyanarayana Singh Guduru Venkat Rao duvvur nageshwar reddy Mitnala Sasikala Basic Science and Translational Research division Asian Healthcare Foundation AIG Hospitals Hyderabad India division of Cell and Molecular Biology National institute of Nutrition Hyderabad India National Animal Resource Facility for Biomedical Research Hyderabad India department of Biochemistry Osmania University Hyderabad India department of Surgical Gastroenterology Asian Institute of Gastroenterology Hyderabad India department of Gastroenterology Asian Institute of Gastroenterology Hyderabad India

Chronic pancreatitis (CP) is a progressive inflammatory disorder of the pancreas. It is predominantly idiopathic (with an unknown cause) in India and mostly due to alcohol in the West. diabetes that occur secondary to chronic pancreatitis (T3c diabetes) is often brittle, and is difficult to attain normoglycemia with conventional treatment requiring multiple doses of insulin. Mild and severe model of CP was induced in mice by repeated intraperitoneal injections of cerulein and L-arginine respectively with an intent to study islet dysfunction and develop therapeutic strategy in animal models of CP. dietary intervention of epigallocatechin-3-gallate (EGCG) was tested in both the models of CP for its beneficial effects on insulin secretory functions. Pancreata collected upon euthanasia were used to study alterations in the morphology of pancreatic parenchyma and inflammation by staining with H&E and fibrotic changes by Masson’s trichrome and picrosirius staining. Insulin secretory functions of islets were evaluated to test the efficacy of the dietary intervention on β-cell functions. Intraperitoneal glucose tolerance test was performed to monitor the glucose homeostasis before and after the dietary intervention. Both the models resulted in CP with dispersed acini, inflammation and fibrosis. The loss of acini and extent of fibrosis was more in L-arginine model. 2-fold improvement in glucose-stimulated insulin secretory functions of islets was observed with 0.5% EGCG dietary intervention in cerulein model of CP and 1.6-fold in L-arginine model of CP. A further improvement in insulin secretion by 3.2-fold was observed with additional dietary supplements like N-acetyl cysteine, curcumin in combination with EGCG. Our results thus demonstrate and highlight the therapeutic potential of dietary green tea (EGCG) supplementation in reversing islet dysfunction and improving glucose homeostasis in experimental chronic pancreatitis in mice.

关键词： dietary Intervention C57BL6/J Mice Epigallocatechin-3-Gallate N-Acetyl Cysteine Curcumin Chronic Pancreatitis Islets Glucose Stimulated Insulin Secretion

Pain in chronic pancreatitis: Managing beyond the pancreatic duct

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World Journal of Gastroenterology 2013年第38期19卷 6319-6328页

作者： Rupjyoti Talukdar d nageshwar reddy department of Medical Gastroenterology Asian Institute of GastroenterologySomajigudaHyderabad 500082India Asian Healthcare Foundation SomajigudaHyderabad 500082India

Chronic pancreatitis(CP)continues to be a clinical challenge.Persistent or recurrent abdominal pain is the most compelling symptom that drives patients to seek medical care.Unfortunately,in spite of using several treatment approaches in the clinical setting,there is no single specific treatment modality that can be earmarked as a cure for this disease.Traditionally,ductal hypertension has been associated with causation of pain in CP;and patients are often subjected to endotherapy and surgery with a goal to decompress the pancreatic duct.Recent studies on humans(clinical and laboratory based)and experimental models have put forward several mechanisms,including neuroimmune alterations,which could be responsible for pain.This might explain the partial or no response to single modality treatment in a significant proportion of patients.The current review discusses the recent concepts of pain generation in CP and evidence based therapeutic approaches(other than ductal decompression)to handle persistent or recurrent pain.We focus primarily on parenchymal and neural components;and discuss the role of antioxidants and the existing controversies,drugs that interfere with neural transmission,pancreatic enzyme supplementation,celiac neurolysis,and pancreatic resection procedures.The review concludes with the treatment approach that we follow at our institute.

关键词： Pain Chronic pancreatitis Nociception Neuroplasticity Antioxidant micronutrients Pregabalin Pancreatic enzymes