Publications by authors named "Kochhar R"

Article Synopsis
  • Acute pancreatitis (AP) is a serious condition that can range from mild to severe, with complications like infections and organ failure becoming more common due to the increased presence of multi-drug-resistant organisms linked to improper antibiotic use.
  • * The study aims to explore the experiences of patients with suspected infected pancreatic necrosis (IPN), focusing on identifying the prevalence of multi-drug-resistant organisms (MDROs) and understanding their antibiotic resistance.
  • * Data was collected from 130 patients at a tertiary hospital in India, revealing that a majority had significant pancreatic necrosis, with high rates of organ failure and infections, particularly in the respiratory tract, and showing specific microbial resistance patterns.
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Background: The standard salvage technique used for difficult bile duct cannulation is precut sphincterotomy, whereas endoscopic ultrasound-guided rendezvous technique (EUS-RV) is a relatively newer method. Prospective comparative data between these 2 techniques as salvage for biliary access in patients with benign biliary disease and difficult bile duct cannulation is lacking.

Objective: To compare EUS-RV and precut sphincterotomy as salvage technique for difficult bile duct cannulation in benign biliary obstruction.

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Background: In patients with squamous cell carcinoma of the anus (SCCA), magnetic resonance (MR) imaging is recommended for pre-treatment staging prior to chemo-radiotherapy (CRT), but large-scale evaluation of its staging performance is lacking.

Methods: We re-characterised pre-treatment MRs from 228 patients with non-metastatic SCCA treated consecutively by CRT (2006-2015) at one UK cancer centre. We derived TN staging from tumour size (mrTr) and nodal involvement (mrN), and additionally characterised novel beyond TN features such as extramural vascular invasion (mrEMVI) and tumour signal heterogeneity (mrTSH).

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Introduction: Low-grade appendiceal mucinous neoplasms (LAMNs) are classified as non-perforated (pTis, pT3) or perforated (pT4), and considered precursors of pseudomyxoma peritonei (PMP). This study aims to quantify the risk of developing PMP from pTis and pT3 LAMNs.

Materials And Methods: Retrospective analysis of a prospectively collected database identified LAMN patients referred to a specialist centre from 2004 to 2019.

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Article Synopsis
  • - A new machine learning tool was developed to predict the risk of post-ERCP pancreatitis (PEP) using data from 12 clinical trials, aiming to improve decision-making regarding patient care.
  • - The tool was trained on 7389 patients, considering various risk factors and interventions, achieving a predictive accuracy (AUC) of 0.70 in the training phase and 0.74 in a pilot study with 135 patients.
  • - This study shows that the model can effectively help identify patients at low risk for PEP, potentially reducing unnecessary post-procedural monitoring.
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Polymer microparticles are often used to encapsulate drugs for sustained drug-release treatments. One of the ways they are manufactured is by using a solvent extraction process, in which the polymer solution is emulsified into an aqueous bulk phase using a surfactant as a stabilizing agent, followed by the removal of the solvent. The radius of a polymer drop decreases as a function of time until the polymer reaches the gelling point, after which it is separated and dried.

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Cytoreductive surgery (CRS) with or without hyperthermic intraperitoneal chemotherapy (HIPEC) is the mainstay of potentially curative surgical treatment for malignancies that have spread to peritoneal surfaces. This surgical procedure is however associated with high morbidity and appropriate patient selection and planning is therefore essential. Available multimodality imaging techniques include CT with oral and intravenous contrast, MRI including use of dedicated peritoneal protocol and FDG-PET/CT.

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Pancreatic fluid collections (PFCs) result from injury to the pancreas from acute or chronic pancreatitis, surgery, or trauma. Management of these collections has evolved over the last 2 decades. The choice of interventions includes percutaneous, endoscopic, minimally invasive surgery, or a combined approach.

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Aim: The aim of the study is to check the antibacterial efficacy of various ayurvedic oils used as a solvent with zinc oxide for preparing endodontic sealers.

Materials And Methods: Forty-five extracted premolars were taken and were cut coronally and apically such that 7 mm of tooth specimen was prepared. Teeth were sterilized by autoclaving inoculated with and incubated for 24 h.

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Acute pancreatitis is an acute inflammatory condition of the pancreas that has not only local but systemic effects as well. Venous thrombosis is one such complication which can give rise to thrombosis of the peripheral vasculature in the form of deep vein thrombosis, pulmonary embolism, and splanchnic vein thrombosis. The prevalence of these complications increases with the severity of the disease and adds to the adverse outcomes profile.

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Article Synopsis
  • Recent use of larger metal stents for walled-off necrosis (WON) has shown higher effectiveness but prior studies did not include cases with significant solid debris.
  • A trial with 48 patients compared the success of plastic versus metal stents for drainage of symptomatic WON, finding that plastic stents are non-inferior to metal stents in treatment success (87.5% vs 83.3%).
  • While the metal stent group had a shorter procedure duration, both groups had similar total procedures and minor adverse events, necessitating larger studies for definitive conclusions.
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Background: There are limited studies on the impact of gender on training and career advancement in gastroenterology.

Aim: The aim was to study this impact and understand the perceptions of work-life balance and beliefs regarding gender dynamics among gastroenterologists in India and other South Asian countries.

Methods: A web-based survey was conducted among trainees and attending physicians in South Asia from November 15, 2021, to March 30, 2022.

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Article Synopsis
  • Caustic ingestion can cause serious long-term health issues, including esophageal stricture and increased cancer risk, yet only a few studies have looked into the detailed tissue changes caused by such injuries.
  • A retrospective study evaluated 39 surgical specimens from patients who experienced complications due to caustic ingestion between 2008 and 2020, finding that most had significant tissue damage such as deep inflammation and structural changes.
  • The findings suggest that caustic ingestion primarily results in severe mucosal damage and inflammation, contributing to complications like refractory stricture, but no cases of dysplasia were identified in the examined tissues.
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Pancreatic fistula is a highly morbid complication of pancreatitis. External pancreatic fistulas result when pancreatic secretions leak externally into the percutaneous drains or external wound (following surgery) due to the communication of the peripancreatic collection with the main pancreatic duct (MPD). Internal pancreatic fistulas include communication of the pancreatic duct (directly or via intervening collection) with the pleura, pericardium, mediastinum, peritoneal cavity, or gastrointestinal tract.

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Background And Aim: While European Society of Pediatric Gastroenterology Hepatology and Nutrition advocates a no-biopsy pathway for the diagnosis of celiac disease (CeD) in children if IgA anti-tissue transglutaminase antibody (anti-tTG ab) titer is ≥10-fold upper limit of normal (ULN) and have a positive IgA anti-endomysial antibody (EMA); the data for anti-tTG Ab titer-based diagnosis of CeD in adults is still emerging. We planned to validate if IgA anti-tTG Ab titer ≥10-fold predicts villous abnormalities of modified Marsh grade ≥2 in Asian adult patients with CeD.

Methods: We recruited 937 adult patients with positive anti-tTG Ab from two databases, including AIIMS Celiac Clinic and Indian National Biorepository.

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Background And Aim: Celiac disease (CeD) has now become a global disease with a worldwide prevalence of 0.67%. Despite being a common disease, CeD is often not diagnosed and there is a significant delay in its diagnosis.

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Background: Although both nonsteroidal anti-inflammatory drugs (NSAIDs) and opioids are used for analgesia in acute pancreatitis (AP), the analgesic of choice is not known. We compared buprenorphine, an opioid, and diclofenac, an NSAID, for analgesia in AP.

Methods: In a double-blind randomized controlled trial, AP patients were randomized to receive intravenous diclofenac or intravenous buprenorphine.

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Objectives: The incidence of anal squamous cell carcinoma (ASCC) is increasing worldwide, with a significant proportion of patients treated with curative intent having recurrence. The ability to accurately predict progression-free survival (PFS) and overall survival (OS) would allow for development of personalised treatment strategies. The aim of the study was to train and external test radiomic/clinical feature derived time-to-event prediction models.

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Article Synopsis
  • Proton pump inhibitors (PPIs) are widely prescribed medications used for treating gastric acid-related disorders, but concerns about inappropriate usage have emerged over the years.
  • There are worries regarding the safety and adverse effects of long-term PPI use, emphasizing the need for better management practices known as PPI stewardship.
  • The Indian Society of Gastroenterology has developed guidelines using a modified Delphi process to optimize PPI use and enhance clinician awareness on appropriate indications and durations for prescribing them.
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The occurrence of diabetes mellitus (DM) in pancreatitis is being increasingly recognized lately. Diabetes can develop not only with chronic pancreatitis but even after the first episode of acute pancreatitis (AP). The incidence of diabetes after AP varies from 18% to 23% in 3 years and reaches up to 40% over 5 years.

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  • Endoscopic dilation is highlighted as the main method for treating caustic esophageal strictures (CES), and this study aims to compare the effectiveness of bougie versus balloon dilators.
  • Data from 189 CES patients over 16 years was analyzed, showing that bougie dilators had significantly better outcomes in terms of technical success and both short- and long-term clinical success compared to balloon dilators.
  • Despite similar adverse event rates in both groups, results indicated that bougie dilators are the preferred choice due to their higher success rates in treating CES.
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Background: The data evaluating contrast-induced-acute kidney injury (AKI) in patients with acute pancreatitis is scarce. This study aimed to compare the frequency of AKI in patients with acute necrotizing pancreatitis undergoing non-contrast computed tomography (NCCT) with those undergoing contrast-enhanced computed tomography (CECT) during hospitalization.

Methods: This prospective randomized controlled trial (CTRI/2019/12/022206) screened consecutive patients with acute pancreatitis for eligibility and randomly allocated patients with acute necrotizing pancreatitis (based on CECT in the first week of illness) and normal renal functions to receive either NCCT or CECT during hospitalization.

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