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Papers by suprabhat giri

Efficacy and safety of endosonography‐guided transvascular needle aspiration of thoracic and abdominal lesions: A systematic review and meta‐analysis

Journal of Clinical Ultrasound, Feb 14, 2023

Maternal and fetal outcomes in pregnant patients with non-cirrhotic portal hypertension: A systematic review and meta-analysis

Obstetric Medicine, Jan 17, 2023

Underwater versus conventional endoscopic mucosal resection for sessile colorectal polyps: an updated systematic review and meta-analysis

Revista Espanola De Enfermedades Digestivas, 2022

Inferior vena cava web diagnosed on endoscopic ultrasound

Gastrointestinal Endoscopy, Jun 1, 2023

Risk of post-ERCP pancreatitis is increased in patients with end-stage renal disease – a meta-analysis

Clinics and Research in Hepatology and Gastroenterology, Apr 1, 2023

IDDF2022-ABS-0141 Endoscopic ultrasound-guided cystogastrostomy is technically feasible, safe and effective in toddlers and small children

Clinical Gastroenterology, Sep 1, 2022

Letter: predictive role of magnetic resonance elastography in chronic liver disease – still a long way to go

Alimentary Pharmacology & Therapeutics, Feb 9, 2022

EDITORS, We read with great interest the recent article by Higuchi et al,1 evaluating the associa... more EDITORS, We read with great interest the recent article by Higuchi et al,1 evaluating the association between the assessment of liver stiffness by magnetic resonance elastography (MRE) and the development of hepatic and extrahepatic complications including mortality. The authors reported an increased risk of hepatocellular carcinoma (HCC), hepatic decompensation and mortality with an increase in liver stiffness but not for major adverse cardiovascular events (MACE), and extrahepatic cancer. However, there are some issues that need to be addressed. The study included consecutive patients with chronic liver disease (CLD) who were evaluated with MRE. However, the definition of CLD that was used to include patients in the study is not clear. This study was a singlecentre study with a disproportionately large number of hepatitis C virus (HCV)infected patients which prevents its generalisation. Patients with moderate/advanced fibrosis and cirrhosis had a higher proportion of patients with diabetes mellitus (DM), dyslipidaemia and hypertension compared to those with minimal fibrosis. Obesity and metabolic syndrome are proinflammatory states, associated with a higher level of IL6, reduced IL10/IL6 ratio,2 reduced IL10/IL17 ratio and elevated macrophage M1/M2ratio.3 This proinflammatory cytokine state promotes progression of liver damage leading to hepatic decompensation even without the development of clinically significant portal hypertension. Thus, use of propensity scorematched analysis would have helped in better estimation of the association. Lastly, significant liver fibrosis on MRE was found to be an independent predictor for the presence of coronary artery calcification (CAC) in patients with nonalcoholic fatty liver disease (NAFLD) in previous studies.4,5 Also, previous metaanalyses have shown increased risks of cardiovascular disease (CVD)related mortality, carotid plaque and cerebrocardiovascular events in HCVinfected patients.6,7 This association was stronger in populations with a higher prevalence of diabetes or hypertension.6 Chronic viral hepatitis [both hepatitis B virus (HBV) and HCV] have been associated with the development of extrahepatic cancers like gastric, colorectal, pancreatic, gallbladder, renal, ovarian and lymphoma.8,9 However, whether liver fibrosis associated with HCV, HBV and NAFLD contributes to increased risk of MACE and extrahepatic cancers, still remains a question. Overall, we would like to congratulate the authors for conducting this study with a large sample size. This study has a potential implication for the noninvasive prognostication of patients with liver fibrosis or cirrhosis. Furthermore, prospective studies are required to validate the findings of this study, before incorporating routine MRE as a standard investigation for patients with CLD.

Efficacy and Safety of Transjugular Intrahepatic Portosystemic Shunt Creation for Budd-Chiari Syndrome: A Systematic Review and Meta-Analysis

Journal of Vascular and Interventional Radiology, Nov 1, 2022

Rapid on-site evaluation (ROSE) versus macroscopic on-site evaluation (MOSE) for endoscopic ultrasound-guided sampling of solid pancreatic lesions: a paired comparative analysis using newer-generation fine needle biopsy needles

PubMed, May 5, 2023

Background: Rapid on-site examination (ROSE) during endoscopic ultrasound-guided fine needle biop... more Background: Rapid on-site examination (ROSE) during endoscopic ultrasound-guided fine needle biopsy (EUS-FNB) has been a subject of debate. We compared the yield of EUS-FNB with adequacy assessed using macroscopic on-site evaluation (MOSE), and smear cytology with adequacy confirmed by ROSE, acquired using the same needle. Methods: Consecutive patients with solid pancreatic lesions (SPLs) who underwent EUS-FNB of pancreatic solid lesions between January 2021 and July 2022 were included. Demographic details, site and size of lesion, number of passes, and the diagnosis by cytology and histopathology of core tissue were noted. The first pass was used for ROSE adequacy assessment and was subsequently sent for cytological assessment. Additional passes were taken subsequently to acquire core tissue. Adequacy was confirmed by MOSE (whitish core of more than 4 mm). Final cytology and histopathology (HPE) were compared for diagnostic accuracy. Results: One hundred fifty-five patients were included in the analysis during the study period (mean age 55.1+12.9 years; 60% male; 77% in pancreatic head; median size 3.7 cm). The final diagnosis was malignancy in 129, while 26 were negative for malignancy. Sensitivity and specificity for ROSE with cytology in detecting malignant SPLs were 96.9% and 100%, respectively. HPE with MOSE had sensitivity and specificity of 96.1% and 100%, respectively. A comparison of diagnostic accuracy showed no significant difference (P>0.99) between HPE with MOSE and ROSE with cytology, using an FNB needle. Conclusion: MOSE is as good as ROSE in terms of diagnostic yield for solid pancreatic lesions sampled using newer-generation EUS biopsy needles.

CRAB score for prediction of colectomy within 2 years following admission for acute severe ulcerative colitis

PubMed, Apr 7, 2023

Background: The Oxford and Swedish indexes were developed to predict in-hospital colectomy in acu... more Background: The Oxford and Swedish indexes were developed to predict in-hospital colectomy in acute severe ulcerative colitis (ASUC), but not long-term prediction, and all these indexes were based on Western data. Our study aimed to analyze the predictors of colectomy within 3 years of ASUC in an Indian cohort and derive a simple predictive score. Methods: A prospective observational study was conducted in a tertiary health care center in South India over a period of 5 years. All patients admitted with ASUC were followed up for a period of 24 months after the index admission, to look for progression to colectomy. Results: A total of 81 (47 male) patients were included in the derivation cohort. Fifteen (18.5%) patients required colectomy during a follow-up period of 24 months. On regression analysis, C-reactive protein (CRP) and serum albumin were independent predictors of 24-month colectomy. The CRAB (CRP + AlBumin) score was obtained by multiplying coefficient of beta to albumin and CRP (CRAB score = CRP x 0.2 - Albumin x 0.26). The CRAB score demonstrated an AUROC of 0.923 and a score of >0.4 with a sensitivity of 82% and specificity of 92% for the prediction of 2-year colectomy following ASUC. The score was validated in a validation cohort of 31 patients, and at >0.4, the score had a sensitivity of 83% and a specificity of 96% in predicting colectomy. Conclusion: CRAB score is a simple prognostic score that can predict 2-year colectomy in ASUC patients with high sensitivity and specificity.

Plugged percutaneous liver biopsy using Tru-cut needle and coils: A retrospective study

Indian Journal of Gastroenterology, Oct 1, 2022

CRAB score for prediction of colectomy within 2 years following admission for acute severe ulcerative colitis

Saudi Journal of Gastroenterology

Background: The Oxford and Swedish indexes were developed to predict in-hospital colectomy in acu... more Background: The Oxford and Swedish indexes were developed to predict in-hospital colectomy in acute severe ulcerative colitis (ASUC), but not long-term prediction, and all these indexes were based on Western data. Our study aimed to analyze the predictors of colectomy within 3 years of ASUC in an Indian cohort and derive a simple predictive score. Methods: A prospective observational study was conducted in a tertiary health care center in South India over a period of 5 years. All patients admitted with ASUC were followed up for a period of 24 months after the index admission, to look for progression to colectomy. Results: A total of 81 (47 male) patients were included in the derivation cohort. Fifteen (18.5%) patients required colectomy during a follow-up period of 24 months. On regression analysis, C-reactive protein (CRP) and serum albumin were independent predictors of 24-month colectomy. The CRAB (CRP + AlBumin) score was obtained by multiplying coefficient of beta to albumin an...

Clinical and Experimental Hepatology

Aim of the study: Endoscopic variceal ligation (EVL) is important for emergency as well as prophy... more Aim of the study: Endoscopic variceal ligation (EVL) is important for emergency as well as prophylactic management of esophageal varices. Early bleeding after EVL is associated with significant morbidity and mortality. Assessing the likelihood of early post-EVL bleeding and its determinants can help deciding therapeutic strategies for high-risk patients. The aim of the present meta-analysis was to identify predictors of early bleeding after EVL. Material and methods: A comprehensive search of the literature was conducted from 2000 to November 2021 for studies evaluating the incidence, predictors and outcome of post-EVL bleeding. Pooled odds ratios (OR), mean difference (MD) and their 95% confidence intervals (CI) were calculated for prognostic variables. Results: A total of 16 studies with data on 13,378 patients were included in the meta-analysis. Among 34 parameters, 14 parameters were assessed for association with early bleeding after EVL. Lower hemoglobin at admission (MD = 1.11, 95% CI:-1.91 to-0.31), higher MELD score (MD = 2.00, 95% CI: 0.51-3.50), associated gastric varices (OR = 5.99, 95% CI: 1.06-33.90), higher number of bands (MD = 0.49, 95% CI: 0.02-0.97), and peptic esophagitis (OR = 11.38, 95% CI: 1.21-106.81) were significantly associated with increased risk of bleeding. However, there was significant heterogeneity among the studies with respect to all the analyzed parameters. Conclusions: Major predictors for early post-EVL bleeding in cirrhosis are admission hemoglobin level and MELD score, associated gastric varices, number of bands deployed during EVL, and peptic esophagitis on follow-up endoscopy. These risk factors may be useful for risk stratification after EVL in cirrhotics.

Nutritional Management in Patients with Chronic Liver Disease Difficulties and Hurdles Faced by Physicians: A Preliminary Survey

Journal of Clinical and Experimental Hepatology

Impact of macroscopic on‐site evaluation on the diagnostic outcomes of endoscopic ultrasound‐guided fine‐needle aspiration

Diagnostic Cytopathology

Efficacy and safety of endosonography‐guided transvascular needle aspiration of thoracic and abdominal lesions: A systematic review and meta‐analysis

Journal of Clinical Ultrasound

Diagnostic outcome and safety of plugged liver biopsy in high-risk patients: a systematic review and meta-analysis

Acta Radiologica

Background Percutaneous liver biopsy is the gold standard test for the assessment of liver diseas... more Background Percutaneous liver biopsy is the gold standard test for the assessment of liver disease. In patients with coagulopathy, ascites, post-transplantation, and hypervascular tumors, biopsy is associated with increased risk of adverse events (AEs). Transjugular liver biopsy (TJLB) is recommended in these conditions but is expensive and unavailable at many centers. Plugged liver biopsy (PLB) provides an alternate diagnostic modality in these high-risk cases. Purpose To analyze the pooled diagnostic outcome and safety of PLB in high-risk cases. Material and Methods A literature search of various databases from January 1990 to July 2022 was conducted for studies evaluating the outcome of PLB in high-risk cases. The primary outcomes were pooled sample adequacy and AEs. Pooled event rates across studies were expressed with summative statistics. Results A total of 17 studies (2329 patients) were included in the meta-analysis. The pooled proportion of sample adequacy was 98.9% (95% co...

Risk of Bleeding with Endoscopic Ultrasound-Guided Tissue Acquisition in Patients on Antithrombotic Therapy: A Systematic Review and Meta-Analysis

Digestive Diseases and Sciences

Efficacy and safety of endosonography‐guided transvascular needle aspiration of thoracic and abdominal lesions: A systematic review and meta‐analysis

Journal of Clinical Ultrasound, Feb 14, 2023

Maternal and fetal outcomes in pregnant patients with non-cirrhotic portal hypertension: A systematic review and meta-analysis

Obstetric Medicine, Jan 17, 2023

Underwater versus conventional endoscopic mucosal resection for sessile colorectal polyps: an updated systematic review and meta-analysis

Revista Espanola De Enfermedades Digestivas, 2022

Inferior vena cava web diagnosed on endoscopic ultrasound

Gastrointestinal Endoscopy, Jun 1, 2023

Risk of post-ERCP pancreatitis is increased in patients with end-stage renal disease – a meta-analysis

Clinics and Research in Hepatology and Gastroenterology, Apr 1, 2023

IDDF2022-ABS-0141 Endoscopic ultrasound-guided cystogastrostomy is technically feasible, safe and effective in toddlers and small children

Clinical Gastroenterology, Sep 1, 2022

Letter: predictive role of magnetic resonance elastography in chronic liver disease – still a long way to go

Alimentary Pharmacology & Therapeutics, Feb 9, 2022

EDITORS, We read with great interest the recent article by Higuchi et al,1 evaluating the associa... more EDITORS, We read with great interest the recent article by Higuchi et al,1 evaluating the association between the assessment of liver stiffness by magnetic resonance elastography (MRE) and the development of hepatic and extrahepatic complications including mortality. The authors reported an increased risk of hepatocellular carcinoma (HCC), hepatic decompensation and mortality with an increase in liver stiffness but not for major adverse cardiovascular events (MACE), and extrahepatic cancer. However, there are some issues that need to be addressed. The study included consecutive patients with chronic liver disease (CLD) who were evaluated with MRE. However, the definition of CLD that was used to include patients in the study is not clear. This study was a singlecentre study with a disproportionately large number of hepatitis C virus (HCV)infected patients which prevents its generalisation. Patients with moderate/advanced fibrosis and cirrhosis had a higher proportion of patients with diabetes mellitus (DM), dyslipidaemia and hypertension compared to those with minimal fibrosis. Obesity and metabolic syndrome are proinflammatory states, associated with a higher level of IL6, reduced IL10/IL6 ratio,2 reduced IL10/IL17 ratio and elevated macrophage M1/M2ratio.3 This proinflammatory cytokine state promotes progression of liver damage leading to hepatic decompensation even without the development of clinically significant portal hypertension. Thus, use of propensity scorematched analysis would have helped in better estimation of the association. Lastly, significant liver fibrosis on MRE was found to be an independent predictor for the presence of coronary artery calcification (CAC) in patients with nonalcoholic fatty liver disease (NAFLD) in previous studies.4,5 Also, previous metaanalyses have shown increased risks of cardiovascular disease (CVD)related mortality, carotid plaque and cerebrocardiovascular events in HCVinfected patients.6,7 This association was stronger in populations with a higher prevalence of diabetes or hypertension.6 Chronic viral hepatitis [both hepatitis B virus (HBV) and HCV] have been associated with the development of extrahepatic cancers like gastric, colorectal, pancreatic, gallbladder, renal, ovarian and lymphoma.8,9 However, whether liver fibrosis associated with HCV, HBV and NAFLD contributes to increased risk of MACE and extrahepatic cancers, still remains a question. Overall, we would like to congratulate the authors for conducting this study with a large sample size. This study has a potential implication for the noninvasive prognostication of patients with liver fibrosis or cirrhosis. Furthermore, prospective studies are required to validate the findings of this study, before incorporating routine MRE as a standard investigation for patients with CLD.

Efficacy and Safety of Transjugular Intrahepatic Portosystemic Shunt Creation for Budd-Chiari Syndrome: A Systematic Review and Meta-Analysis

Journal of Vascular and Interventional Radiology, Nov 1, 2022

Rapid on-site evaluation (ROSE) versus macroscopic on-site evaluation (MOSE) for endoscopic ultrasound-guided sampling of solid pancreatic lesions: a paired comparative analysis using newer-generation fine needle biopsy needles

PubMed, May 5, 2023

Background: Rapid on-site examination (ROSE) during endoscopic ultrasound-guided fine needle biop... more Background: Rapid on-site examination (ROSE) during endoscopic ultrasound-guided fine needle biopsy (EUS-FNB) has been a subject of debate. We compared the yield of EUS-FNB with adequacy assessed using macroscopic on-site evaluation (MOSE), and smear cytology with adequacy confirmed by ROSE, acquired using the same needle. Methods: Consecutive patients with solid pancreatic lesions (SPLs) who underwent EUS-FNB of pancreatic solid lesions between January 2021 and July 2022 were included. Demographic details, site and size of lesion, number of passes, and the diagnosis by cytology and histopathology of core tissue were noted. The first pass was used for ROSE adequacy assessment and was subsequently sent for cytological assessment. Additional passes were taken subsequently to acquire core tissue. Adequacy was confirmed by MOSE (whitish core of more than 4 mm). Final cytology and histopathology (HPE) were compared for diagnostic accuracy. Results: One hundred fifty-five patients were included in the analysis during the study period (mean age 55.1+12.9 years; 60% male; 77% in pancreatic head; median size 3.7 cm). The final diagnosis was malignancy in 129, while 26 were negative for malignancy. Sensitivity and specificity for ROSE with cytology in detecting malignant SPLs were 96.9% and 100%, respectively. HPE with MOSE had sensitivity and specificity of 96.1% and 100%, respectively. A comparison of diagnostic accuracy showed no significant difference (P>0.99) between HPE with MOSE and ROSE with cytology, using an FNB needle. Conclusion: MOSE is as good as ROSE in terms of diagnostic yield for solid pancreatic lesions sampled using newer-generation EUS biopsy needles.

CRAB score for prediction of colectomy within 2 years following admission for acute severe ulcerative colitis

PubMed, Apr 7, 2023

Background: The Oxford and Swedish indexes were developed to predict in-hospital colectomy in acu... more Background: The Oxford and Swedish indexes were developed to predict in-hospital colectomy in acute severe ulcerative colitis (ASUC), but not long-term prediction, and all these indexes were based on Western data. Our study aimed to analyze the predictors of colectomy within 3 years of ASUC in an Indian cohort and derive a simple predictive score. Methods: A prospective observational study was conducted in a tertiary health care center in South India over a period of 5 years. All patients admitted with ASUC were followed up for a period of 24 months after the index admission, to look for progression to colectomy. Results: A total of 81 (47 male) patients were included in the derivation cohort. Fifteen (18.5%) patients required colectomy during a follow-up period of 24 months. On regression analysis, C-reactive protein (CRP) and serum albumin were independent predictors of 24-month colectomy. The CRAB (CRP + AlBumin) score was obtained by multiplying coefficient of beta to albumin and CRP (CRAB score = CRP x 0.2 - Albumin x 0.26). The CRAB score demonstrated an AUROC of 0.923 and a score of >0.4 with a sensitivity of 82% and specificity of 92% for the prediction of 2-year colectomy following ASUC. The score was validated in a validation cohort of 31 patients, and at >0.4, the score had a sensitivity of 83% and a specificity of 96% in predicting colectomy. Conclusion: CRAB score is a simple prognostic score that can predict 2-year colectomy in ASUC patients with high sensitivity and specificity.

Plugged percutaneous liver biopsy using Tru-cut needle and coils: A retrospective study

Indian Journal of Gastroenterology, Oct 1, 2022

CRAB score for prediction of colectomy within 2 years following admission for acute severe ulcerative colitis

Saudi Journal of Gastroenterology

Background: The Oxford and Swedish indexes were developed to predict in-hospital colectomy in acu... more Background: The Oxford and Swedish indexes were developed to predict in-hospital colectomy in acute severe ulcerative colitis (ASUC), but not long-term prediction, and all these indexes were based on Western data. Our study aimed to analyze the predictors of colectomy within 3 years of ASUC in an Indian cohort and derive a simple predictive score. Methods: A prospective observational study was conducted in a tertiary health care center in South India over a period of 5 years. All patients admitted with ASUC were followed up for a period of 24 months after the index admission, to look for progression to colectomy. Results: A total of 81 (47 male) patients were included in the derivation cohort. Fifteen (18.5%) patients required colectomy during a follow-up period of 24 months. On regression analysis, C-reactive protein (CRP) and serum albumin were independent predictors of 24-month colectomy. The CRAB (CRP + AlBumin) score was obtained by multiplying coefficient of beta to albumin an...

Clinical and Experimental Hepatology

Aim of the study: Endoscopic variceal ligation (EVL) is important for emergency as well as prophy... more Aim of the study: Endoscopic variceal ligation (EVL) is important for emergency as well as prophylactic management of esophageal varices. Early bleeding after EVL is associated with significant morbidity and mortality. Assessing the likelihood of early post-EVL bleeding and its determinants can help deciding therapeutic strategies for high-risk patients. The aim of the present meta-analysis was to identify predictors of early bleeding after EVL. Material and methods: A comprehensive search of the literature was conducted from 2000 to November 2021 for studies evaluating the incidence, predictors and outcome of post-EVL bleeding. Pooled odds ratios (OR), mean difference (MD) and their 95% confidence intervals (CI) were calculated for prognostic variables. Results: A total of 16 studies with data on 13,378 patients were included in the meta-analysis. Among 34 parameters, 14 parameters were assessed for association with early bleeding after EVL. Lower hemoglobin at admission (MD = 1.11, 95% CI:-1.91 to-0.31), higher MELD score (MD = 2.00, 95% CI: 0.51-3.50), associated gastric varices (OR = 5.99, 95% CI: 1.06-33.90), higher number of bands (MD = 0.49, 95% CI: 0.02-0.97), and peptic esophagitis (OR = 11.38, 95% CI: 1.21-106.81) were significantly associated with increased risk of bleeding. However, there was significant heterogeneity among the studies with respect to all the analyzed parameters. Conclusions: Major predictors for early post-EVL bleeding in cirrhosis are admission hemoglobin level and MELD score, associated gastric varices, number of bands deployed during EVL, and peptic esophagitis on follow-up endoscopy. These risk factors may be useful for risk stratification after EVL in cirrhotics.

Nutritional Management in Patients with Chronic Liver Disease Difficulties and Hurdles Faced by Physicians: A Preliminary Survey

Journal of Clinical and Experimental Hepatology

Impact of macroscopic on‐site evaluation on the diagnostic outcomes of endoscopic ultrasound‐guided fine‐needle aspiration

Diagnostic Cytopathology

Efficacy and safety of endosonography‐guided transvascular needle aspiration of thoracic and abdominal lesions: A systematic review and meta‐analysis

Journal of Clinical Ultrasound

Diagnostic outcome and safety of plugged liver biopsy in high-risk patients: a systematic review and meta-analysis

Acta Radiologica

Background Percutaneous liver biopsy is the gold standard test for the assessment of liver diseas... more Background Percutaneous liver biopsy is the gold standard test for the assessment of liver disease. In patients with coagulopathy, ascites, post-transplantation, and hypervascular tumors, biopsy is associated with increased risk of adverse events (AEs). Transjugular liver biopsy (TJLB) is recommended in these conditions but is expensive and unavailable at many centers. Plugged liver biopsy (PLB) provides an alternate diagnostic modality in these high-risk cases. Purpose To analyze the pooled diagnostic outcome and safety of PLB in high-risk cases. Material and Methods A literature search of various databases from January 1990 to July 2022 was conducted for studies evaluating the outcome of PLB in high-risk cases. The primary outcomes were pooled sample adequacy and AEs. Pooled event rates across studies were expressed with summative statistics. Results A total of 17 studies (2329 patients) were included in the meta-analysis. The pooled proportion of sample adequacy was 98.9% (95% co...

Risk of Bleeding with Endoscopic Ultrasound-Guided Tissue Acquisition in Patients on Antithrombotic Therapy: A Systematic Review and Meta-Analysis

Digestive Diseases and Sciences