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Shivaraj Afzalpurkar 3 Articles
Influence of biliary stents on the diagnostic outcome of endoscopic ultrasound–guided tissue acquisition from solid pancreatic lesions: a systematic review and meta-analysis
Suprabhat Giri, Shivaraj Afzalpurkar, Sumaswi Angadi, Jijo Varghese, Sridhar Sundaram
Clin Endosc 2023;56(2):169-179.   Published online February 15, 2023
AbstractAbstract PDFSupplementary MaterialPubReaderePub
/Aims: This meta-analysis analyzed the effect of an indwelling biliary stent on endoscopic ultrasound (EUS)–guided tissue acquisition from pancreatic lesions.
A literature search was performed to identify studies published between 2000 and July 2022 comparing the diagnostic outcomes of EUS-TA in patients with or without biliary stents. For non-strict criteria, samples reported as malignant or suspicious for malignancy were included, whereas for strict criteria, only samples reported as malignant were included in the analysis.
Nine studies were included in this analysis. The odds of an accurate diagnosis were significantly lower in patients with indwelling stents using both non-strict (odds ratio [OR], 0.68; 95% confidence interval [CI], 0.52–0.90) and strict criteria (OR, 0.58; 95% CI, 0.46–0.74). The pooled sensitivity with and without stents were similar (87% vs. 91%) using non-strict criteria. However, patients with stents had a lower pooled sensitivity (79% vs. 88%) when using strict criteria. The sample inadequacy rate was comparable between groups (OR, 1.12; 95% CI, 0.76–1.65). The diagnostic accuracy and sample inadequacy were comparable between plastic and metal biliary stents.
The presence of a biliary stent may negatively affect the diagnostic outcome of EUS-TA for pancreatic lesions.


Citations to this article as recorded by  
  • Role of Endoscopic Ultrasound in Diagnosis of Pancreatic Ductal Adenocarcinoma
    Abhirup Chatterjee, Jimil Shah
    Diagnostics.2023; 14(1): 78.     CrossRef
  • 2,181 View
  • 112 Download
  • 1 Crossref
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A prospective study of fully covered self-expandable metal stents for refractory benign pancreatic duct strictures
Bhavik Bharat Shah, Gajanan Ashokrao Rodge, Usha Goenka, Shivaraj Afzalpurkar, Mahesh Kumar Goenka
Clin Endosc 2022;55(6):793-800.   Published online April 4, 2022
AbstractAbstract PDFPubReaderePub
/Aims: Fully covered self-expanding metal stents (FCSEMSs) are a relatively novel option for treating painful main pancreatic duct refractory strictures in patients with chronic pancreatitis. Herein, we aimed to assess the efficacy, feasibility, and safety of FCSEMSs in this patient group.
This prospective single-center study included patients who underwent endoscopic retrograde pancreatography with FCSEMS placement. The primary endpoints were the technical and clinical success rates. A reduction in visual analog scale pain score of >50% compared with that before stent placement was defined as clinical success. Secondary endpoints were resolution of pancreatic strictures on fluoroscopy during endoscopic retrograde pancreatography and the development of stent-related adverse events.
Thirty-six patients were included in the analysis. The technical success rate was 100% (n=36) and the clinical success rate was 86.1% (n=31). There was a significant increase in stricture diameter from 1.7 mm to 3.5 mm (p<0.001) after stent removal. The mean visual analog scale pain score showed statistically significant improvement. At 19 months of follow-up, 55.6% of the patients were asymptomatic. Stent migration (16.7%), intolerable abdominal pain (8.3%), development of de novo strictures (8.3%), and mild pancreatitis (2.8%) were the most common adverse events.
FCSEMS placement showed good technical and clinical success rates for achieving pain relief in patients with refractory main pancreatic duct strictures.


Citations to this article as recorded by  
  • Citric Acid Loaded Hydrogel-Coated Stent for Dissolving Pancreatic Duct Calculi
    Jing Li, Yanwei Lv, Zheng Chen, Jiulong Zhao, Shige Wang
    Gels.2024; 10(2): 125.     CrossRef
  • Self-expanding metallic stent for refractory pancreatic duct stricture in chronic pancreatitis: A prospective follow-up study
    Praveer Rai, Pankaj Kumar, Ashok Kumar, Sana Asari, Kartik Agarwal, Mayank, Ravi V. Krishna Kishore, Prabhaker Mishra
    Indian Journal of Gastroenterology.2023;[Epub]     CrossRef
  • Quality of life after endoscopic procedures for chronic pancreatitis: A multicentre study
    Mikael Parhiala, Camilla Nøjgaard, Andreas Bartholdy, Anne Waage, Povilas Ignatavičius, Trond Engjom, Georg Dimcevski, Ingrid Kvåle Nordaas, Evangelos Kalaitzakis, Asbjørn M. Drewes, Amer Hadi, Søren S. Olesen, Jakob L. Poulsen, Johanna Laukkarinen
    United European Gastroenterology Journal.2023; 11(9): 884.     CrossRef
  • Pancreatic duct stents
    Jin Hui Yi, Zhao Shen Li, Liang Hao Hu
    Journal of Digestive Diseases.2022; 23(12): 675.     CrossRef
  • 2,809 View
  • 279 Download
  • 4 Web of Science
  • 4 Crossref
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Mucosal incision-assisted biopsy versus endoscopic ultrasound-assisted tissue acquisition for subepithelial lesions: a systematic review and meta-analysis
Suprabhat Giri, Shivaraj Afzalpurkar, Sumaswi Angadi, Sridhar Sundaram
Clin Endosc 2022;55(5):615-625.   Published online August 4, 2022
AbstractAbstract PDFSupplementary MaterialPubReaderePub
/Aims: Mucosal incision-assisted biopsy (MIAB) for tissue acquisition (TA) from subepithelial lesions (SELs) is emerging as an alternative to endoscopic ultrasound (EUS)-guided TA. Only a limited number of studies compared the diagnostic utility of MIAB and EUS for upper gastrointestinal (GI) SELs; therefore, we conducted this systematic review and meta-analysis.
A comprehensive literature search from January 2020 to January 2022 was performed to compare the diagnostic accuracy and safety of MIAB and EUS-guided TA for upper GI SELs.
Seven studies were included in this meta-analysis. The pooled technical success rate (risk ratio [RR], 0.96; 95% confidence interval [CI], 0.89–1.04) and procedural time (mean difference=–4.53 seconds; 95% CI, –22.38 to 13.31] were comparable between both the groups. The overall chance of obtaining a positive diagnostic yield was lower with EUS than with MIAB for all lesions (RR, 0.83; 95% CI, 0.71–0.98) but comparable when using a fine-needle biopsy needle (RR, 0.93; 95% CI, 0.83–1.04). The positive diagnostic yield of MIAB was higher for lesions <20 mm (RR, 0.75; 95% CI, 0.63–0.89). Six studies reported no adverse events.
MIAB can be considered an effective alternative to EUS-guided TA for upper GI SELs without an increased risk of adverse events.


Citations to this article as recorded by  
  • Technical outcomes and postprocedural courses of mucosal incision‐assisted biopsy for possible gastric gastrointestinal stromal tumors: A series of 48 cases (with video)
    Eriko Koizumi, Osamu Goto, Shun Nakagome, Tsugumi Habu, Yumiko Ishikawa, Kumiko Kirita, Hiroto Noda, Kazutoshi Higuchi, Takeshi Onda, Teppei Akimoto, Jun Omori, Naohiko Akimoto, Katsuhiko Iwakiri
    DEN Open.2024;[Epub]     CrossRef
  • The Diagnostic Approach of Benign Esophageal Tumors: A Narrative Review
    Alex R. Jones, Preksha Vankawala, Tarek Sawas
    Current Treatment Options in Gastroenterology.2024; 22(2): 44.     CrossRef
  • Unroofing of subepithelial lesions in the upper gastrointestinal tract using cold snare: an easy and efficient technique for diagnosis
    Bernhard Morell, Frans Olivier The, Christoph Gubler, Fritz Ruprecht Murray
    Clinical Endoscopy.2024; 57(2): 274.     CrossRef
  • Diagnostic yield of endoscopic and EUS-guided biopsy techniques in subepithelial lesions of the upper GI tract: a systematic review
    Cynthia A. Verloop, Jacqueline A.C. Goos, Marco J. Bruno, Rutger Quispel, Lydi M.J.W. van Driel, Lieke Hol
    Gastrointestinal Endoscopy.2024; 99(6): 895.     CrossRef
  • Small gastric subepithelial lesions: A sand in the eye
    Tanyaporn Chantarojanasiri, Nikhil Sonthalia, Rashid N. Lui
    Journal of Gastroenterology and Hepatology.2024; 39(7): 1207.     CrossRef
  • Approach to Small Gastric Subepithelial Lesions
    Moon Won Lee, Bong Eun Lee
    The Korean Journal of Helicobacter and Upper Gastrointestinal Research.2023; 23(1): 28.     CrossRef
  • Is the canalization to obtain deep biopsy of gastrointestinal subepithelial tumors miniprobe-guidded as an alternative to conventional known techniques?
    Modesto Varas Lorenzo, Ramón Abad Belando
    Revista Española de Enfermedades Digestivas.2023;[Epub]     CrossRef
  • Role of Advanced Gastrointestinal Endoscopy in the Comprehensive Management of Neuroendocrine Neoplasms
    Harishankar Gopakumar, Vinay Jahagirdar, Jagadish Koyi, Dushyant Singh Dahiya, Hemant Goyal, Neil R. Sharma, Abhilash Perisetti
    Cancers.2023; 15(16): 4175.     CrossRef
  • 2,436 View
  • 136 Download
  • 7 Web of Science
  • 8 Crossref
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