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Papers by Amol Bapaye

Research paper thumbnail of Indications and Outcomes of Per Oral Endoscopic Myotomy from Mouth to Anus

Gastrointestinal Endoscopy Clinics of North America

Research paper thumbnail of Emerging trends of infections in patients with liver cirrhosis - a clinical audit from a tertiary centre in Western India

Journal of Clinical and Experimental Hepatology

Research paper thumbnail of Su1716 ENDOSCOPIC MANAGEMENT OF COLONIC INTUSSUSCEPTION BY ESD- CASE SERIES

Gastrointestinal Endoscopy, 2018

Introduction: Adenoma detection rate (ADR) is the primary quality indicator for colonoscopy; howe... more Introduction: Adenoma detection rate (ADR) is the primary quality indicator for colonoscopy; however, it is difficult to obtain in terms of time and personnel. Polyp detection rate (PDR) is an alternative indicator easily evaluated from administrative data. The main aim of the study was to assess whether PDR and ADR are correlated and to determine the conversion factor to predict ADR from PDR in preventive (screening and FOBT+) colonoscopies. Methods: The retrospective study included asymptomatic individuals aged 45-75 who underwent preventive colonoscopy in 2012-2015 as part of Czech multicentric study monitoring metabolic risk factors of colorectal cancer. Spearman's correlation coefficient was used to assess the relation between individual PDR and ADR. The resulting conversion factor to predict ADR from PDR was obtained by linear regression. Results: In total, the study included 1614 preventive colonoscopies performed by 16 endoscopists. The correlation between PDR and ADR in all preventive colonoscopies was high and statistically significant (Rs 0.82; p < 0.001). There is a stronger correlation between PDR and ADR in men (Rs 0.74; p Z 0.002) and in screening colonoscopies (Rs 0.85; p < 0.001). The conversion factor to convert ADR from PDR is 0.7185, 0.7582, and 0.6703 for all preventive, FOBT+ and screening colonoscopies respectively. Conclusion: There is a strong correlation between PDR and ADR; due to better accessibility, PDR may replace ADR in colonoscopy quality assessment. ADR may be estimated from PDR using a conversion factor that varies according to colonoscopy indication and gender of endoscoped individuals. With respect to the minimum ADR requested, i.e. 25% recommended by ASGE and ESGE identically, all preventive colonoscopies should reach PDR ! 35%. Supportedby grant17-31909A.

Research paper thumbnail of Management of patients after failed peroral endoscopic myotomy: a multicenter study

Endoscopy, 2020

Background Although peroral endoscopic myotomy (POEM) is highly effective for the management of a... more Background Although peroral endoscopic myotomy (POEM) is highly effective for the management of achalasia, clinical failures may occur. The optimal management of patients who fail POEM is not well known. This study aimed to compare the outcomes of different management strategies in patients who had failed POEM. Methods This was an international multicenter retrospective study at 16 tertiary centers between January 2012 and November 2019. All patients who underwent POEM and experienced persistent or recurrent symptoms (Eckardt score > 3) were included. The primary outcome was to compare the rates of clinical success (Eckardt score ≤ 3) between different management strategies. Results 99 patients (50 men [50.5 %]; mean age 51.4 [standard deviation (SD) 16.2]) experienced clinical failure during the study period, with a mean (SD) Eckardt score of 5.4 (0.3). A total of 29 patients (32.2 %) were managed conservatively and 70 (71 %) underwent retreatment (repeat POEM 33 [33 %], pneumat...

Research paper thumbnail of Estudio Multicentro Internacional Sobre El Manejo De Pacientes Después De Un Poem Fallido

41 Congreso de la Sociedad Española de Endoscopia Digestiva (SEED), 2019

Research paper thumbnail of Third-space endoscopy – can we see light at the end of the tunnel?

Research paper thumbnail of Consensus guidelines on the role of cholangioscopy to diagnose indeterminate biliary stricture

HPB, 2021

BACKGROUND Indeterminate strictures pose a therapeutic dilemma. In recent years, cholangioscopy h... more BACKGROUND Indeterminate strictures pose a therapeutic dilemma. In recent years, cholangioscopy has evolved and the availability of cholangioscopy has increased. However, the position of cholangioscopy in the diagnostic algorithm to diagnose malignancy have not been well established. We aim to develop a consensus statement regarding the clinical role of cholangioscopy in the diagnosis of indeterminate biliary strictures. METHODS The international experts reviewed the evidence and modified the statements using a three-step modified Delphi method. Each statement achieves consensus when it has at least 80% agreement. RESULTS Nine final statements were formulated. An indeterminate biliary stricture is defined as that of uncertain etiology under imaging or tissue diagnosis. When available, cholangioscopic assessment and guided biopsy during the first round of ERCP may reduce the need to perform multiple procedures. Cholangioscopy are helpful in diagnosing malignant biliary strictures by both direct visualization and targeted biopsy. The absence of disease progression for at least 6 months is supportive of non-malignant etiology. Direct per-oral cholangioscopy provides the largest accessory channel, better image definition, with image enhancement but is technically demanding. Image enhancement during cholangioscopy may increase the diagnostic sensitivity of visual impression of malignant biliary strictures. Cholangioscopic imaging characteristics including tumor vessels, papillary projection, nodular or polypoid mass, and infiltrative lesions are highly suggestive for neoplastic/malignant biliary disease. The risk of cholangioscopy related cholangitis is higher than in standard ERCP, necessitating prophylactic antibiotics and ensuring adequate biliary drainage. Per-oral cholangioscopy may not be the modality of choice in the evaluation of distal biliary strictures due to inherent technical difficulties. CONCLUSION Evidence supports that cholangioscopy has an adjunct role to abdominal imaging and ERCP tissue acquisition in order to evaluate and diagnose indeterminate biliary strictures.

Research paper thumbnail of New Fully Covered Large-Bore Removable Metal Stent - with Anti-Migratory Flanges for Drainage of Pancreatic Fluid Collections: Results of a Single Center Experience

Research paper thumbnail of Mo1261 Stent Patency in Endoscopic Ultrasound Guided Transmural Versus Transpapillary Biliary Drainage

Gastrointestinal Endoscopy, 2017

ERCP can be performed has been described. The benefits of EUS-directed transgastric ERCP (EDGE) a... more ERCP can be performed has been described. The benefits of EUS-directed transgastric ERCP (EDGE) are that it is minimally invasive and performed by a single team. The clinical outcomes of this new technique have not been compared to the surgical standard. Methods: Charts of patients from May 2005 to October 2016 with RYGB anatomy having undergone ERCP at four tertiary care centers were captured in a dedicated registry. Any RYGB patient having undergone either LA-ERCP or EDGE was included in the study. Patient demographics along with procedural and clinical outcomes were measured for each group. Chi Square and T tests were conducted to compare demographics and outcomes for both groups. Results: A total of 71 patients (n Z 28 EDGE, nZ43 LA ERCP) were included in this study. There was no significant difference in the baseline demographics between the two groups (age, sex), or the indication for ERCP. There was no significant difference in the technical success of EDGE gastrogastric fistula (96.4%) vs LA-gastrostomy creation (100%). The success rate of achieving therapeutic ERCP (EDGE 96.4% vs LA-ERCP 97.8%) and number of ERCP (EDGE 1.2 vs LA-ERCP 1.02) needed to achieve clinical resolution was similar between both groups. The overall adverse event rate for EDGE, 21% (6/28) and LA-ERCP, 18% (8/43) was similar. The total procedure time (79 vs 183.5 min; p value <.00001) and length of hospital stay (0.7 vs 2.65 days p value Z 0.0003) was significantly shorter for EDGE compared to LA-ERCP. The overall weight change after EDGE was-1.4lbs at an average 20 week follow-up. Conclusions: Pancreaticobiliary therapy in RYGB is a growing challenge. The optimal biliary access procedure would be one that can be performed by a single team in a minimally invasive fashion. This comparative analysis suggests that the EDGE procedure has similar technical success and adverse events compared to LA-ERCP with the benefit of significantly shorter procedure times and hospital stay. Compared to LA-ERCP, EDGE may offer a minimally invasive, effective option, with less resource utilization, and without significant weight gain for pancreaticobiliary disease in RYGB patients. Prospective studies are needed to confirm this notion.

Research paper thumbnail of 874 Comparative Evaluation of PerOral Endoscopic Myotomy (POEM) for the Treatment of Achalasia in Patients With Failed Heller Myotomy vs Patients Without a History of Surgical Myotomy: A Multicenter Retrospective Cohort Study

Gastrointestinal Endoscopy, 2016

Research paper thumbnail of 1044 Elective Two-Stage Tunnelling Esd (ETSD) for Giant Circumferential Rectal Lateral Spreading Tumor (LST)

Gastrointestinal Endoscopy, 2017

the abdominal wall may decrease the risk of postoperative peritonitis, secondary to stool leakage... more the abdominal wall may decrease the risk of postoperative peritonitis, secondary to stool leakage or to tube dislocation.

Research paper thumbnail of UEG Week 2016 Poster Presentations

United European Gastroenterology Journal, 2016

Research paper thumbnail of Per-Oral Endoscopic Pyloromyotomy (G-POEM) and Per-Rectal Endoscopic Myotomy (PREM)

Gastrointestinal Interventional Endoscopy

After the clinical success of per-oral endoscopic myotomy (POEM) for treatment of achalasia, the ... more After the clinical success of per-oral endoscopic myotomy (POEM) for treatment of achalasia, the principle of submucosal tunneling and mucosal flap valve has been used in several other areas of the gastrointestinal tract. Per-Oral Endoscopic Pyloromyotomy (POEP, POP) or Gastric Per-Oral Endoscopic Myotomy (G-POEM) is a relatively new procedure for the treatment of refractory gastroparesis. Similarly, per-rectal endoscopic myotomy (PREM) has been described for the treatment of Hirschsprung’s disease. This chapter discusses the indications, patient selection, pre-procedure workup, procedure details, and status of G-POEM and PREM.

Research paper thumbnail of Modified Pocket Endoscopic Submucosal Dissection Technique for Resection of a Giant Rectal Lateral Spreading Tumor

Journal of Digestive Endoscopy, 2019

Research paper thumbnail of 61st Annual Conference of Indian Society of Gastroenterology, Virtual Diamond Jubilee ISGCON 2020, 19-20th December 2020

Indian Journal of Gastroenterology, 2020

An open label trial to compare viral suppression with 0.5 and 1.0 mg doses of entecavir in treatm... more An open label trial to compare viral suppression with 0.5 and 1.0 mg doses of entecavir in treatment naive hepatitis B related decompensated cirrhosis

Research paper thumbnail of Use of a novel lumen apposing metallic stent for drainage of the bile duct and gallbladder: Long term outcomes of a prospective international trial

Digestive Endoscopy

BACKGROUND Long-term placement of lumen apposing metal stents (LAMS) with high lumen apposing for... more BACKGROUND Long-term placement of lumen apposing metal stents (LAMS) with high lumen apposing force may result in adverse events. The aim of the current study was to assess the long-term efficacy and safety of a self-approximating LAMS with lower lumen apposing force for EUS-guided choledochoduodenostomy (EUS-CDS) and gallbladder drainage (EUS-GBD). METHODS Five Asian institutions participated in this study. Consecutive patients suffering from obstructive jaundice with failed ERCP or acute cholecystitis that were at high risk for cholecystectomy were recruited. We evaluated the technical and clinical success rates, adverse events rates, types interventions through the stent and the patency profile. RESULTS From June 2017 to Oct 2018, a total 53 patients received EUS-CDS (26) and EUS-GBD (27). The technical and clinical success rates were similar between the two groups (88.5% vs 88.9%, P = 1 and 88.5% vs 88.9%, P = 1 respectively). The differences in 30-day mortality rates [2 (7.7%) vs 2 (7.7%), P = 1] and adverse events [3(11.5%) vs 3(11.5%), P = 1] did not reach significance. Regarding long-term outcomes, 2 patients in each group suffered from adverse events (P = 1). One patient in the EUS-GBD patient who was on direct oral anticoagulant suffered from stent induced bleeding. CONCLUSION The self-approximating LAMS with lower lumen apposing force was effective and safe with a low risk of buried stent syndrome and bleeding in the longer term.

Research paper thumbnail of Per Oral Endoscopic Myotomy for Zenker’s Diverticulum

Journal of Clinical Gastroenterology

INTRODUCTION Endoscopic management of Zenker diverticuli (ZD) has traditionally been via septotom... more INTRODUCTION Endoscopic management of Zenker diverticuli (ZD) has traditionally been via septotomy technique. The recent development of tunneling technique has shown to be both efficacious and safe. The aim of this study is to evaluate the tunneling technique using per oral endoscopic myotomy (Z-POEM) versus septotomy. METHODS Patients who underwent endoscopic management of ZD either by Z-POEM or septotomy from March 2017 until November 2020 from 9 international academic centers were included. Demographics, clinical data preprocedure and postprocedure, procedure time, adverse events, and hospital length of stay were analyzed. RESULTS A total of 101 patients (mean age 74.9 y old, 55.4% male) were included: septotomy (n=49), Z-POEM (n=52). Preprocedure Functional Oral Intake Scale score and Eckardt score was 5.3 and 5.4 for the septotomy group and 5.9 and 5.15 for the Z-POEM group. Technical success was achieved in 98% of the Z-POEM group and 100% of the septotomy group. Clinical success was achieved in 84% and 92% in the septotomy versus Z-POEM groups. Adverse events occurred in 30.6% (n=15) in septotomy group versus 9.6% (n=5) in the Z-POEM group (P=0.017). Reintervention for ongoing symptoms occurred in 7 patients in the septotomy group and 3 patients in the Z-POEM group. Mean hospital length of stay was shorter for the Z-POEM group, at 1.5 versus 1.9 days. CONCLUSIONS A tunneling technique via the Z-POEM procedure is an efficacious and safe endoscopic treatment for ZD. Z-POEM is a safer procedure with a statistically significant reduction in adverse events compared with traditional septotomy technique.

Research paper thumbnail of Long-term outcomes of per-oral endoscopic myotomy in achalasia patients with a minimum follow-up of 4 years: a multicenter study

Endoscopy International Open

Background and study aims Per-oral endoscopic myotomy (POEM) is associated with a short-term clin... more Background and study aims Per-oral endoscopic myotomy (POEM) is associated with a short-term clinical response of 82 % to 100 % in treatment of patients with achalasia. Data are limited on the long-term durability of the clinical response in these patients. The aim of this study was to determine the long-term outcomes of patients undergoing POEM for management of achalasia. Methods This was a retrospective multicenter cohort study of consecutive patients who underwent POEM for management of achalasia. Patients had a minimum of 4 years follow-up. Clinical response was defined by an Eckardt score ≤ 3. Results A total of 146 patients were included from 11 academic medical centers. Mean (± SD) age was 49.8 (± 16) years and 79 (54 %) were female. The most common type of achalasia was type II, seen in 70 (47.9 %) patients, followed by type I seen in 41 (28.1 %) patients. Prior treatments included: pneumatic dilation in 29 (19.9 %), botulinum toxin injection in 13 (8.9 %) and Heller myotom...

Research paper thumbnail of Mo1781 CLINICAL AUDIT OF ENDOSCOPIC SUBMUCOSAL DISSECTION (ESD) FOR COLORECTAL MUCOSAL LESIONS AT A SINGLE CENTER FROM A REGION NON ENDEMIC FOR COLORECTAL CANCER – EVALUATING THE CLINICAL OUTCOMES AND LEARNING CURVE

Gastrointestinal Endoscopy

Research paper thumbnail of Indian consensus on gastroesophageal reflux disease in adults: A position statement of the Indian Society of Gastroenterology

Indian Journal of Gastroenterology

The Indian Society of Gastroenterology developed this evidence-based practice guideline for manag... more The Indian Society of Gastroenterology developed this evidence-based practice guideline for management of gastroesophageal reflux disease (GERD) in adults. A modified Delphi process was used to develop this consensus containing 58 statements, which were generated by electronic voting iteration as well as face-to-face meeting and review of the supporting literature primarily from India. These statements include 10 on epidemiology, 8 on clinical presentation, 10 on investigations, 23 on treatment (including medical, endoscopic, and surgical modalities), and 7 on complications of GERD. When the proportion of those who voted either to accept completely or with minor reservation was 80% or higher, the statement was regarded as accepted. The prevalence of GERD in India ranges from 7.6% to 30%, being < 10% in most population studies, and higher in cohort studies. The dietary factors associated with GERD include use of spices and non-vegetarian food. Helicobacter pylori is thought to have a negative relation with GERD; H. pylori negative patients have higher grade of symptoms of GERD and esophagitis. Less than 10% of GERD patients in India have erosive esophagitis. In patients with occasional or mild symptoms, antacids and histamine H2 receptor blockers (H2RAs) may be used, and proton pump inhibitors (PPI) should be used in patients with frequent or severe symptoms. Prokinetics have limited proven role in management of GERD.

Research paper thumbnail of Indications and Outcomes of Per Oral Endoscopic Myotomy from Mouth to Anus

Gastrointestinal Endoscopy Clinics of North America

Research paper thumbnail of Emerging trends of infections in patients with liver cirrhosis - a clinical audit from a tertiary centre in Western India

Journal of Clinical and Experimental Hepatology

Research paper thumbnail of Su1716 ENDOSCOPIC MANAGEMENT OF COLONIC INTUSSUSCEPTION BY ESD- CASE SERIES

Gastrointestinal Endoscopy, 2018

Introduction: Adenoma detection rate (ADR) is the primary quality indicator for colonoscopy; howe... more Introduction: Adenoma detection rate (ADR) is the primary quality indicator for colonoscopy; however, it is difficult to obtain in terms of time and personnel. Polyp detection rate (PDR) is an alternative indicator easily evaluated from administrative data. The main aim of the study was to assess whether PDR and ADR are correlated and to determine the conversion factor to predict ADR from PDR in preventive (screening and FOBT+) colonoscopies. Methods: The retrospective study included asymptomatic individuals aged 45-75 who underwent preventive colonoscopy in 2012-2015 as part of Czech multicentric study monitoring metabolic risk factors of colorectal cancer. Spearman's correlation coefficient was used to assess the relation between individual PDR and ADR. The resulting conversion factor to predict ADR from PDR was obtained by linear regression. Results: In total, the study included 1614 preventive colonoscopies performed by 16 endoscopists. The correlation between PDR and ADR in all preventive colonoscopies was high and statistically significant (Rs 0.82; p < 0.001). There is a stronger correlation between PDR and ADR in men (Rs 0.74; p Z 0.002) and in screening colonoscopies (Rs 0.85; p < 0.001). The conversion factor to convert ADR from PDR is 0.7185, 0.7582, and 0.6703 for all preventive, FOBT+ and screening colonoscopies respectively. Conclusion: There is a strong correlation between PDR and ADR; due to better accessibility, PDR may replace ADR in colonoscopy quality assessment. ADR may be estimated from PDR using a conversion factor that varies according to colonoscopy indication and gender of endoscoped individuals. With respect to the minimum ADR requested, i.e. 25% recommended by ASGE and ESGE identically, all preventive colonoscopies should reach PDR ! 35%. Supportedby grant17-31909A.

Research paper thumbnail of Management of patients after failed peroral endoscopic myotomy: a multicenter study

Endoscopy, 2020

Background Although peroral endoscopic myotomy (POEM) is highly effective for the management of a... more Background Although peroral endoscopic myotomy (POEM) is highly effective for the management of achalasia, clinical failures may occur. The optimal management of patients who fail POEM is not well known. This study aimed to compare the outcomes of different management strategies in patients who had failed POEM. Methods This was an international multicenter retrospective study at 16 tertiary centers between January 2012 and November 2019. All patients who underwent POEM and experienced persistent or recurrent symptoms (Eckardt score > 3) were included. The primary outcome was to compare the rates of clinical success (Eckardt score ≤ 3) between different management strategies. Results 99 patients (50 men [50.5 %]; mean age 51.4 [standard deviation (SD) 16.2]) experienced clinical failure during the study period, with a mean (SD) Eckardt score of 5.4 (0.3). A total of 29 patients (32.2 %) were managed conservatively and 70 (71 %) underwent retreatment (repeat POEM 33 [33 %], pneumat...

Research paper thumbnail of Estudio Multicentro Internacional Sobre El Manejo De Pacientes Después De Un Poem Fallido

41 Congreso de la Sociedad Española de Endoscopia Digestiva (SEED), 2019

Research paper thumbnail of Third-space endoscopy – can we see light at the end of the tunnel?

Research paper thumbnail of Consensus guidelines on the role of cholangioscopy to diagnose indeterminate biliary stricture

HPB, 2021

BACKGROUND Indeterminate strictures pose a therapeutic dilemma. In recent years, cholangioscopy h... more BACKGROUND Indeterminate strictures pose a therapeutic dilemma. In recent years, cholangioscopy has evolved and the availability of cholangioscopy has increased. However, the position of cholangioscopy in the diagnostic algorithm to diagnose malignancy have not been well established. We aim to develop a consensus statement regarding the clinical role of cholangioscopy in the diagnosis of indeterminate biliary strictures. METHODS The international experts reviewed the evidence and modified the statements using a three-step modified Delphi method. Each statement achieves consensus when it has at least 80% agreement. RESULTS Nine final statements were formulated. An indeterminate biliary stricture is defined as that of uncertain etiology under imaging or tissue diagnosis. When available, cholangioscopic assessment and guided biopsy during the first round of ERCP may reduce the need to perform multiple procedures. Cholangioscopy are helpful in diagnosing malignant biliary strictures by both direct visualization and targeted biopsy. The absence of disease progression for at least 6 months is supportive of non-malignant etiology. Direct per-oral cholangioscopy provides the largest accessory channel, better image definition, with image enhancement but is technically demanding. Image enhancement during cholangioscopy may increase the diagnostic sensitivity of visual impression of malignant biliary strictures. Cholangioscopic imaging characteristics including tumor vessels, papillary projection, nodular or polypoid mass, and infiltrative lesions are highly suggestive for neoplastic/malignant biliary disease. The risk of cholangioscopy related cholangitis is higher than in standard ERCP, necessitating prophylactic antibiotics and ensuring adequate biliary drainage. Per-oral cholangioscopy may not be the modality of choice in the evaluation of distal biliary strictures due to inherent technical difficulties. CONCLUSION Evidence supports that cholangioscopy has an adjunct role to abdominal imaging and ERCP tissue acquisition in order to evaluate and diagnose indeterminate biliary strictures.

Research paper thumbnail of New Fully Covered Large-Bore Removable Metal Stent - with Anti-Migratory Flanges for Drainage of Pancreatic Fluid Collections: Results of a Single Center Experience

Research paper thumbnail of Mo1261 Stent Patency in Endoscopic Ultrasound Guided Transmural Versus Transpapillary Biliary Drainage

Gastrointestinal Endoscopy, 2017

ERCP can be performed has been described. The benefits of EUS-directed transgastric ERCP (EDGE) a... more ERCP can be performed has been described. The benefits of EUS-directed transgastric ERCP (EDGE) are that it is minimally invasive and performed by a single team. The clinical outcomes of this new technique have not been compared to the surgical standard. Methods: Charts of patients from May 2005 to October 2016 with RYGB anatomy having undergone ERCP at four tertiary care centers were captured in a dedicated registry. Any RYGB patient having undergone either LA-ERCP or EDGE was included in the study. Patient demographics along with procedural and clinical outcomes were measured for each group. Chi Square and T tests were conducted to compare demographics and outcomes for both groups. Results: A total of 71 patients (n Z 28 EDGE, nZ43 LA ERCP) were included in this study. There was no significant difference in the baseline demographics between the two groups (age, sex), or the indication for ERCP. There was no significant difference in the technical success of EDGE gastrogastric fistula (96.4%) vs LA-gastrostomy creation (100%). The success rate of achieving therapeutic ERCP (EDGE 96.4% vs LA-ERCP 97.8%) and number of ERCP (EDGE 1.2 vs LA-ERCP 1.02) needed to achieve clinical resolution was similar between both groups. The overall adverse event rate for EDGE, 21% (6/28) and LA-ERCP, 18% (8/43) was similar. The total procedure time (79 vs 183.5 min; p value <.00001) and length of hospital stay (0.7 vs 2.65 days p value Z 0.0003) was significantly shorter for EDGE compared to LA-ERCP. The overall weight change after EDGE was-1.4lbs at an average 20 week follow-up. Conclusions: Pancreaticobiliary therapy in RYGB is a growing challenge. The optimal biliary access procedure would be one that can be performed by a single team in a minimally invasive fashion. This comparative analysis suggests that the EDGE procedure has similar technical success and adverse events compared to LA-ERCP with the benefit of significantly shorter procedure times and hospital stay. Compared to LA-ERCP, EDGE may offer a minimally invasive, effective option, with less resource utilization, and without significant weight gain for pancreaticobiliary disease in RYGB patients. Prospective studies are needed to confirm this notion.

Research paper thumbnail of 874 Comparative Evaluation of PerOral Endoscopic Myotomy (POEM) for the Treatment of Achalasia in Patients With Failed Heller Myotomy vs Patients Without a History of Surgical Myotomy: A Multicenter Retrospective Cohort Study

Gastrointestinal Endoscopy, 2016

Research paper thumbnail of 1044 Elective Two-Stage Tunnelling Esd (ETSD) for Giant Circumferential Rectal Lateral Spreading Tumor (LST)

Gastrointestinal Endoscopy, 2017

the abdominal wall may decrease the risk of postoperative peritonitis, secondary to stool leakage... more the abdominal wall may decrease the risk of postoperative peritonitis, secondary to stool leakage or to tube dislocation.

Research paper thumbnail of UEG Week 2016 Poster Presentations

United European Gastroenterology Journal, 2016

Research paper thumbnail of Per-Oral Endoscopic Pyloromyotomy (G-POEM) and Per-Rectal Endoscopic Myotomy (PREM)

Gastrointestinal Interventional Endoscopy

After the clinical success of per-oral endoscopic myotomy (POEM) for treatment of achalasia, the ... more After the clinical success of per-oral endoscopic myotomy (POEM) for treatment of achalasia, the principle of submucosal tunneling and mucosal flap valve has been used in several other areas of the gastrointestinal tract. Per-Oral Endoscopic Pyloromyotomy (POEP, POP) or Gastric Per-Oral Endoscopic Myotomy (G-POEM) is a relatively new procedure for the treatment of refractory gastroparesis. Similarly, per-rectal endoscopic myotomy (PREM) has been described for the treatment of Hirschsprung’s disease. This chapter discusses the indications, patient selection, pre-procedure workup, procedure details, and status of G-POEM and PREM.

Research paper thumbnail of Modified Pocket Endoscopic Submucosal Dissection Technique for Resection of a Giant Rectal Lateral Spreading Tumor

Journal of Digestive Endoscopy, 2019

Research paper thumbnail of 61st Annual Conference of Indian Society of Gastroenterology, Virtual Diamond Jubilee ISGCON 2020, 19-20th December 2020

Indian Journal of Gastroenterology, 2020

An open label trial to compare viral suppression with 0.5 and 1.0 mg doses of entecavir in treatm... more An open label trial to compare viral suppression with 0.5 and 1.0 mg doses of entecavir in treatment naive hepatitis B related decompensated cirrhosis

Research paper thumbnail of Use of a novel lumen apposing metallic stent for drainage of the bile duct and gallbladder: Long term outcomes of a prospective international trial

Digestive Endoscopy

BACKGROUND Long-term placement of lumen apposing metal stents (LAMS) with high lumen apposing for... more BACKGROUND Long-term placement of lumen apposing metal stents (LAMS) with high lumen apposing force may result in adverse events. The aim of the current study was to assess the long-term efficacy and safety of a self-approximating LAMS with lower lumen apposing force for EUS-guided choledochoduodenostomy (EUS-CDS) and gallbladder drainage (EUS-GBD). METHODS Five Asian institutions participated in this study. Consecutive patients suffering from obstructive jaundice with failed ERCP or acute cholecystitis that were at high risk for cholecystectomy were recruited. We evaluated the technical and clinical success rates, adverse events rates, types interventions through the stent and the patency profile. RESULTS From June 2017 to Oct 2018, a total 53 patients received EUS-CDS (26) and EUS-GBD (27). The technical and clinical success rates were similar between the two groups (88.5% vs 88.9%, P = 1 and 88.5% vs 88.9%, P = 1 respectively). The differences in 30-day mortality rates [2 (7.7%) vs 2 (7.7%), P = 1] and adverse events [3(11.5%) vs 3(11.5%), P = 1] did not reach significance. Regarding long-term outcomes, 2 patients in each group suffered from adverse events (P = 1). One patient in the EUS-GBD patient who was on direct oral anticoagulant suffered from stent induced bleeding. CONCLUSION The self-approximating LAMS with lower lumen apposing force was effective and safe with a low risk of buried stent syndrome and bleeding in the longer term.

Research paper thumbnail of Per Oral Endoscopic Myotomy for Zenker’s Diverticulum

Journal of Clinical Gastroenterology

INTRODUCTION Endoscopic management of Zenker diverticuli (ZD) has traditionally been via septotom... more INTRODUCTION Endoscopic management of Zenker diverticuli (ZD) has traditionally been via septotomy technique. The recent development of tunneling technique has shown to be both efficacious and safe. The aim of this study is to evaluate the tunneling technique using per oral endoscopic myotomy (Z-POEM) versus septotomy. METHODS Patients who underwent endoscopic management of ZD either by Z-POEM or septotomy from March 2017 until November 2020 from 9 international academic centers were included. Demographics, clinical data preprocedure and postprocedure, procedure time, adverse events, and hospital length of stay were analyzed. RESULTS A total of 101 patients (mean age 74.9 y old, 55.4% male) were included: septotomy (n=49), Z-POEM (n=52). Preprocedure Functional Oral Intake Scale score and Eckardt score was 5.3 and 5.4 for the septotomy group and 5.9 and 5.15 for the Z-POEM group. Technical success was achieved in 98% of the Z-POEM group and 100% of the septotomy group. Clinical success was achieved in 84% and 92% in the septotomy versus Z-POEM groups. Adverse events occurred in 30.6% (n=15) in septotomy group versus 9.6% (n=5) in the Z-POEM group (P=0.017). Reintervention for ongoing symptoms occurred in 7 patients in the septotomy group and 3 patients in the Z-POEM group. Mean hospital length of stay was shorter for the Z-POEM group, at 1.5 versus 1.9 days. CONCLUSIONS A tunneling technique via the Z-POEM procedure is an efficacious and safe endoscopic treatment for ZD. Z-POEM is a safer procedure with a statistically significant reduction in adverse events compared with traditional septotomy technique.

Research paper thumbnail of Long-term outcomes of per-oral endoscopic myotomy in achalasia patients with a minimum follow-up of 4 years: a multicenter study

Endoscopy International Open

Background and study aims Per-oral endoscopic myotomy (POEM) is associated with a short-term clin... more Background and study aims Per-oral endoscopic myotomy (POEM) is associated with a short-term clinical response of 82 % to 100 % in treatment of patients with achalasia. Data are limited on the long-term durability of the clinical response in these patients. The aim of this study was to determine the long-term outcomes of patients undergoing POEM for management of achalasia. Methods This was a retrospective multicenter cohort study of consecutive patients who underwent POEM for management of achalasia. Patients had a minimum of 4 years follow-up. Clinical response was defined by an Eckardt score ≤ 3. Results A total of 146 patients were included from 11 academic medical centers. Mean (± SD) age was 49.8 (± 16) years and 79 (54 %) were female. The most common type of achalasia was type II, seen in 70 (47.9 %) patients, followed by type I seen in 41 (28.1 %) patients. Prior treatments included: pneumatic dilation in 29 (19.9 %), botulinum toxin injection in 13 (8.9 %) and Heller myotom...

Research paper thumbnail of Mo1781 CLINICAL AUDIT OF ENDOSCOPIC SUBMUCOSAL DISSECTION (ESD) FOR COLORECTAL MUCOSAL LESIONS AT A SINGLE CENTER FROM A REGION NON ENDEMIC FOR COLORECTAL CANCER – EVALUATING THE CLINICAL OUTCOMES AND LEARNING CURVE

Gastrointestinal Endoscopy

Research paper thumbnail of Indian consensus on gastroesophageal reflux disease in adults: A position statement of the Indian Society of Gastroenterology

Indian Journal of Gastroenterology

The Indian Society of Gastroenterology developed this evidence-based practice guideline for manag... more The Indian Society of Gastroenterology developed this evidence-based practice guideline for management of gastroesophageal reflux disease (GERD) in adults. A modified Delphi process was used to develop this consensus containing 58 statements, which were generated by electronic voting iteration as well as face-to-face meeting and review of the supporting literature primarily from India. These statements include 10 on epidemiology, 8 on clinical presentation, 10 on investigations, 23 on treatment (including medical, endoscopic, and surgical modalities), and 7 on complications of GERD. When the proportion of those who voted either to accept completely or with minor reservation was 80% or higher, the statement was regarded as accepted. The prevalence of GERD in India ranges from 7.6% to 30%, being < 10% in most population studies, and higher in cohort studies. The dietary factors associated with GERD include use of spices and non-vegetarian food. Helicobacter pylori is thought to have a negative relation with GERD; H. pylori negative patients have higher grade of symptoms of GERD and esophagitis. Less than 10% of GERD patients in India have erosive esophagitis. In patients with occasional or mild symptoms, antacids and histamine H2 receptor blockers (H2RAs) may be used, and proton pump inhibitors (PPI) should be used in patients with frequent or severe symptoms. Prokinetics have limited proven role in management of GERD.