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Shobna Bhatia 2 Articles
Outcomes of Dilation of Recalcitrant Pancreatic Strictures Using a Wire-Guided Cystotome
Sridhar Sundaram, Dhaval Choksi, Aditya Kale, Suprabhat Giri, Biswaranjan Patra, Shobna Bhatia, Akash Shukla
Clin Endosc 2021;54(6):903-908.   Published online March 4, 2021
AbstractAbstract PDFPubReaderePub
/Aims: Pancreatic strictures in chronic pancreatitis are treated using endoscopic retrograde cholangiopancreatography (ERCP) with plastic stent placement. The management of recalcitrant strictures remains a challenge, with the use of a Soehendra stent retriever or a needle knife described in case reports. Here, we discuss our experience with dilation of dominant pancreatic strictures with a 6-Fr cystotome.
A retrospective review of an endoscopy database was performed to search for patients with pancreatic strictures recalcitrant to conventional methods of dilation in which a cystotome was used. Technical success was defined as the successful dilation of the stricture with plastic stent placement. Functional success was defined as substantial pain relief or resolution of pancreatic fistulae.
Ten patients (mean age, 30.8 years) underwent dilation of a dominant pancreatic stricture secondary to chronic pancreatitis, with a 6-Fr cystotome. Seven patients presented with pain. Three patients had pancreatic fistulae (two had pancreatic ascites and one had a pancreaticopleural fistula). The median stricture length was 10 mm (range, 5–25 mm). The head of the pancreas was the most common location of the stricture (60%). Technical and functional success was achieved in all patients. One patient had self-limiting bleeding, whereas another patient developed mild post-ERCP pancreatitis.
The use of a 6-Fr cystotome (diathermy catheter) can be an alternative method for dilation of recalcitrant pancreatic strictures after the failure of conventional modalities.


Citations to this article as recorded by  
  • Treatment of Difficult Pancreatic Duct Strictures Using a Cystotome: A Single-Center Experience
    Jonghyun Lee, Dong Uk Kim, Sung Yong Han
    The Korean Journal of Pancreas and Biliary Tract.2023; 28(4): 108.     CrossRef
  • Approach to management of pancreatic strictures: the gastroenterologist’s perspective
    Vaneet Jearth, Suprabhat Giri, Sridhar Sundaram
    Clinical Journal of Gastroenterology.2021; 14(6): 1587.     CrossRef
  • 3,528 View
  • 87 Download
  • 1 Web of Science
  • 2 Crossref
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Outcomes of Endoscopic Management among Patients with Bile Leak of Various Etiologies at a Tertiary Care Center
Suprabhat Giri, Sridhar Sundaram, Harish Darak, Sanjay Kumar, Shobna Bhatia
Clin Endosc 2020;53(6):727-734.   Published online August 21, 2020
AbstractAbstract PDFPubReaderePub
/Aims: Bile leak is a common complication of cholecystectomy, and it is also observed in other conditions such as ruptured liver abscess, hydatid cyst, and trauma. Endoscopic retrograde cholangiopancreatography (ERCP) is the first-line management for such conditions. However, studies on the outcomes of endoscopic management for bile leaks with etiologies other than post-cholecystectomy injury are extremely limited.
We conducted a retrospective review of patients with symptomatic bile leak who were referred to a tertiary care center and who underwent ERCP between April 2016 and April 2019. The primary outcome was complete symptomatic resolution without extravasation of the contrast medium during the second ERCP conducted after 6 weeks.
In total, 71 patients presented with symptomatic bile leak. The etiologies of bile leak were post-cholecystectomy injury in 34 (47.8%), liver abscess in 20 (28.1%), and post-hydatid cyst surgery in 11 (15.4%) patients. All patients were managed with ERCP, sphincterotomy, and stent placement for 6 weeks, except for one who underwent surgery. The primary outcome was achieved in 65 (91.5%) of 71 patients. There was no significant difference in terms of outcome in relation to the interval between the diagnosis of bile leak and ERCP.
Most patients with bile leak can be successfully managed with ERCP even when performed on an elective basis.


Citations to this article as recorded by  
  • A critical appraisal of the ISGLS definition of biliary leakage after liver resection
    Svenja Sliwinski, Jan Heil, Josephine Franz, Hanan El Youzouri, Michael Heise, Wolf O. Bechstein, Andreas A. Schnitzbauer
    Langenbeck's Archives of Surgery.2023;[Epub]     CrossRef
  • Progress in ERCP Treatment of Biliary Complications in Patients with Hepatic Echinococcosis
    燕泽 林
    Advances in Clinical Medicine.2023; 13(03): 4013.     CrossRef
  • Diagnosis and management of bile leaks after severe liver injury: A Trauma Association of Canada multicenter study
    Morgan Schellenberg, Chad G. Ball, Natthida Owattanapanich, Brent Emigh, Patrick B. Murphy, Bradley Moffat, Brett Mador, Andrew Beckett, Jennie Lee, Emilie Joos, Samuel Minor, Matt Strickland, Kenji Inaba
    Journal of Trauma and Acute Care Surgery.2022; 93(6): 813.     CrossRef
  • Postoperative bile leakage caused by intrahepatic duct injury during right hemicolectomy
    Jaram Lee, Ook Song, Hyeong-Min Park, Soo Young Lee, Chang Hyun Kim, Hyeong Rok Kim
    Medicine.2021; 100(46): e27877.     CrossRef
  • The Need for a Better-Designed Study of the Outcomes of Endoscopic Management of Bile Leak
    Hyung Ku Chon, Eun Ji Shin, Seong-Hun Kim
    Clinical Endoscopy.2020; 53(6): 633.     CrossRef
  • 4,597 View
  • 117 Download
  • 4 Web of Science
  • 5 Crossref
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