Gaurav Kakked | Maharaja Sayajirao University of Baroda (original) (raw)

Papers by Gaurav Kakked

Gastrointestinal Endoscopy, Jun 1, 2019

NCCN guidelines. Secondary outcomes were to identify any surveillance barriers and to determine t... more NCCN guidelines. Secondary outcomes were to identify any surveillance barriers and to determine the natural history of GIST. Methods: A retrospective chart review of all EUS procedures at St. Paul's Hospital (SPH) and Vancouver General Hospital (VGH), Vancouver, Canada was completed from 01/05-06/17 and 01/12-06/17 respectively. Patients with <2 cm GIST were identified. GIST were defined as a hypoechoic lesion arising from the 2 nd or 4 th layer of the GI wall +/-cytologic/histologic diagnosis. Data collected included patient demographics, clinical presentation, initial/subsequent EUS findings, interval between EUS, reasons for not undergoing surveillance EUS, and pathology. Candidates were collated based on the presence of GIST and if appropriate follow-up occurred based on NCCN guidelines. This study was approved by the IRB at SPH and VGH. Results: GIST were identified by EUS in 199 patients, 94 (47%) had lesions <2 cm in size. Mean age at diagnosis was 64 years (SD:12.6), with 52% being female. 77% were referred due to incidental findings at initial endoscopy and 23% were referred based on CT imaging. GIST were identified in the stomach/ esophagus. Of the 94 patients with <2cm GIST, surveillance was recommended in 86 (92%) and 69 (80%) had at least one surveillance EUS completed. Of the 17 patients surveillance was recommended but not completed, the barrier was not identified. Over the review period there was an improvement in surveillance adherence to 100%. During a median follow-up of 6 years (1-10), 66 (96%) lesions remained unchanged in size and 3 lesions increased in size, with only one exceeding 2cm. This lesion remained stable over follow-up examinations. Of the 69 patients with <2cm lesions, 3 were referred to surgery due to high risk features. No patients under surveillance with <2cm lesions developed unresectable disease. Conclusions: SPH and VGH endosonographers recommendations for surveillance of <2cm GIST agreed with current guidelines in 92% of patients. Adherence to recommendations improved to 100% over the study period. The progression rate of small GIST is very low and our evidence supports that surveillance intervals can be increased for patients with small GIST that have been stable over serial examinations.

Gastroenterology, 2019

Background: Hemp derived cannabidiol (CBD) is currently available without a prescription as it is... more Background: Hemp derived cannabidiol (CBD) is currently available without a prescription as it is a non-intoxicating marijuana extract. It is gaining popularity as an alternative treatment strategy for healthcare consumers across a spectrum of disorders. Utilization of CBD oil for disease or symptom management in autoimmune hepatitis (AIH) is unknown, as is its safety profile. Aims: To identify the frequency of CBD oil use in AIH patients and assess impact on symptoms and safety profile using two large AIH specific social media groups. Methods: An invitation to complete a CBD oil-specific questionnaire was posted every other day to well-established AIH Facebook communities (Autoimmune Hepatitis Research Network and Autoimmune Hepatitis Association) during a 10-day study period. Combined membership of social media groups included 2600 individuals with AIH. The survey contained 33 questions and collected patient demographics, disease characteristics, and CBD oil usage. Age ≥ 18 years and an AIH diagnosis by a physician were the eligibility criteria. Results: A total of 371 patients with AIH completed the questionnaire during the study period. Respondents were 91.4% female, 88.9% Caucasian, 88.9% North American, and had a median age of 49 years at survey completion. In regards to AIH, the median age at diagnosis was 42 years and most reported active treatment with an immunosuppressant (92.2%). In regard to fibrosis, 34.5% respondents reported early fibrosis and 32.1% advanced on most recent biopsy. 93 (25%) respondents were ever CBD oil users, with 55 (59%) identified as current users and 38 (41%) prior users. Only 42% of ever CBD oil users alerted their treating doctor they were using CBD oil. There were no differences between characteristics between ever CBD oil users and never users, however there was a trend of lower annual income in the ever CBD oil users (p=0.07) (Table 1). The most frequent AIH symptoms treated with CBD oil was pain (67.7%), poor sleep (62.4%), and fatigue (37.6%). Respondents using CBD oil for these symptoms reported improvement in pain (82%), sleep (87%), and fatigue (61%), yet there were no demographic or patient characteristics different between those with improvement vs. no improvement. In the ever CBD oil users, 17.3% reported they were able to stop a prescription medication because of CBD oil use including pain medication (47%), immunosuppression (24%), and sleep aids (12%). The median duration of CBD oil use was 3 months among current and prior CBD oil users and most common reason stopping CBD oil was cost. Side effects were reported in 3.1% of CBD users, yet there were no reported emergency department visits or hospitalizations related to use. Conclusion: In our study, CBD oil use was prevalent. Respondents reported CBD oil frequently reduced symptoms attributed to AIH without significant side effects.

American Journal of Gastroenterology, 2021

INTRODUCTION: In 2020, only 19% of 63 matched advanced endoscopy (AE) fellows were women. This st... more INTRODUCTION: In 2020, only 19% of 63 matched advanced endoscopy (AE) fellows were women. This study evaluates the gender-specific factors that influence gastroenterologists to pursue careers in AE. METHODS: An anonymous survey was distributed to gastroenterology fellows and attendings through various gastroenterology society online forums. Data were collected on demographics, training, mentorship, current practice, family planning, and career satisfaction. RESULTS: Women comprised 71.1% of the 332 respondents. 24.7% of female fellows plan to pursue an AE career compared with 37.5% of male fellows (P = 0.195). The main motivating factor for both genders was interest in the subject area. Interest in another subspecialty was the main deterring factor for both genders. Women were more deterred by absence of same-sex mentors (P < 0.001), perception of gender-based bias in the workplace (P = 0.009), family planning (P = 0.018), fertility/pregnancy risks from radiation (P < 0.001), ...

Gastrointestinal Endoscopy, 2019

Journal of Surgical Research, 2019

Background: Postsurgical biliary disease in Roux-en-y and cholecystectomies has been investigated... more Background: Postsurgical biliary disease in Roux-en-y and cholecystectomies has been investigated, but less literature exists regarding biliary complications after Whipple procedure (pancreaticoduodenectomy [PD]). Moreover, the hospital burden incurred after this complication has not been previously examined. The aim of this study is to assess the trends in hospitalization for biliary strictures and cholangitis after PD. Materials and methods: The National Inpatient Sample identified all cases with a PD and a primary diagnosis of biliary complication in 2014. Cases were identified using the International Classification of Diseases, Clinical Modification codes. Primary outcomes were association of biliary complications with mortality, cost of admission, and length of stay. Results: A total of 10,145 patients in 2014 were documented with a previous PD. Mortality was 50-fold greater without biliary complications (2.7% versus 0.05%), but a 95% increased length of stay (25.8 d versus 13.2 d, P ¼ 0.014

American Journal of Gastroenterology, 2018

2273_B Figure 2. MRI Abdomen T2 weighted imaging showing an extremely thickened gall bladder wall.

American Journal of Gastroenterology

JAMA Network Open

IMPORTANCE Increased utilization of hepatitis C virus (HCV)-positive liver allografts for liver t... more IMPORTANCE Increased utilization of hepatitis C virus (HCV)-positive liver allografts for liver transplant (LT) has been endorsed as one of several ways to combat national organ shortages. However, HCV-positive donors remain poorly characterized, and Organ Procurement and Transplantation Network regional differences in the utilization of HCV-positive liver allografts are unclear. OBJECTIVE To characterize HCV-positive donors and the allografts that come from them. DESIGN, SETTING, AND PARTICIPANTS In this cross-sectional study, the Scientific Registry of Transplant Recipients database was queried for all donors who underwent HCV testing from June 2015 to December 2018. Clinical and allograft characteristics were evaluated, and utilization across the United States was studied. Patients with positive or negative results for HCV antibody (Ab) and HCV nucleic acid amplification testing (NAT) were included in this study. Donors utilized for living donor transplant and pediatric (age <18 years) recipients were excluded.

Gastrointestinal Endoscopy