Publications by authors named "Manu Nayar"
Background: Abdominal pain is the cardinal symptom of acute pancreatitis (AP), often requiring opioid therapy. This study aimed to investigate the dose-dependent relationship between opioid therapy and moderately severe or severe AP.
Methods: This was a post-hoc analysis of the prospective PAINAP database, which recruited patients with first-time AP from 118 centres across 27 countries between April-June 30, 2022.
Article Synopsis
- IgG4-related disease is a chronic immune disorder with no current approved treatment, and inebilizumab, which targets CD19+ B cells, is being tested as a potential therapy.
- In a phase 3 trial, 135 adults with active IgG4-related disease were randomly assigned to receive either inebilizumab or a placebo, and the primary measure was time until the first disease flare.
- Results showed that patients receiving inebilizumab had significantly fewer disease flares (10% vs. 60% in the placebo group), lower annual flare rates, and higher rates of complete remission without treatment compared to those in the placebo group.
Background: Since there is no current international consensus on the optimal approach for pain management in acute pancreatitis (AP), analgesic practices may vary across different healthcare settings.
Objective: This study explored global disparities in analgesic use, in particular opioids, during admission and at discharge in hospitalised AP patients.
Methods: This was a post hoc analysis of the prospective PAINAP database, which included all admissions for AP between April and June 2022 with a 1-month follow-up.
Background: The effect of analgesic modalities on short-term outcomes in acute pancreatitis remains unknown. However, preclinical models have raised safety concerns regarding opioid use in patients with acute pancreatitis.
Objective: This study aimed to assess the association between analgesics, particularly opioids, and severity and mortality in hospitalised patients with acute pancreatitis.
Background & Aims: Autoimmune pancreatitis (AIP) is an immune-mediated disease of the pancreas with distinct pathophysiology and manifestations. Our aims were to characterize type 1 AIP in a large pan-European cohort and study the effectiveness of current treatment regimens.
Methods: We retrospectively analyzed adults diagnosed since 2005 with type 1 or not-otherwise-specified AIP in 42 European university hospitals.
Background And Aim: During the COVID-19 pandemic, health workers' facial exposure to pathogens has been brought into focus. In this study, we aimed to determine the occurrence and degree of facial contamination to both endoscopists and their assistants during endoscopic procedures to help inform future safety measures.
Methods: Non-sterile visors worn by endoscopist, assistant and room control visors from 50 procedures were swabbed post procedure for culture.
Over 2.5 million gastrointestinal endoscopic procedures are carried out in the United Kingdom (UK) every year. Procedures are carried out with local anaesthetic r with sedation.
View Article and Find Full Text PDFBackground And Aims: International endoscopy societies vary in their approach for credentialing individuals in endoscopic ultrasound (EUS) to enable independent practice; however, there is no consensus in this or its implementation. In 2019, the Joint Advisory Group on GI Endoscopy (JAG) commissioned a working group to examine the evidence relating to this process for EUS. The aim of this was to develop evidence-based recommendations for EUS training and certification in the UK.
View Article and Find Full Text PDFBackground: Endoscopic ultrasound-guided gallbladder drainage (EUS-GBD) is a rescue technique for patients with malignant biliary obstruction who fail conventional treatment with ERCP or EUS-guided biliary drainage. The technique has been successfully employed in the management of acute cholecystitis in patients not fit for surgery. However, the evidence for its use in malignant obstruction is less robust.
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- The study investigated the incidence and risk factors for post pancreatitis diabetes mellitus (PPDM) among patients with acute pancreatitis (AP) in a UK medical center.
- It found that 11% of patients developed PPDM, with a significant relationship between PPDM and the extent of pancreatic necrosis.
- Despite the development of PPDM, it did not lead to worse overall health outcomes, including length of hospital stay or increased mortality rates.
Background And Aims: The incidence of acute pancreatitis (AP) is increasing in the UK. Patients with severe AP require a significant amount of resources to support them during their admission. The ability to predict which patients will develop multiorgan dysfunction remains poor leading to a delay in the identification of these patients and a window of opportunity for early intervention is missed.
View Article and Find Full Text PDFBackground And Study Aim: Immunoglobulin G4-related disease (IgG4-RD) is a rare immune mediated fibroinflammatory condition. Pancreaticobiliary (PB) and head and neck (HN) are two of the most commonly involved anatomical sites. It has been postulated that PB IgG4-RD and HN IgG4-RD have distinct clinical phenotypes.
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- Researchers studied how well special metal tubes called IDSEMS work to help people who had liver transplants and are having trouble with their bile ducts.
- They looked at data from 162 patients treated across nine hospitals in the UK, focusing on how the patients responded to the treatment over time.
- The findings showed that most patients (81%) had their problems completely fixed, but some had issues again after the treatment ended, and a few experienced complications like infections.
Background: Treatment for severe acute severe pancreatitis (SAP) can significantly affect Health-related quality of life (HR-QoL). The effects of different treatment strategies such as endoscopic and surgical necrosectomy on HR-QoL in patients with SAP remain poorly investigated.
Aim: To critically appraise the available evidence on HR-QoL following surgical or endoscopic necrosectomy in patient with SAP.
Introduction: There is a paucity of data on the incidence, risk factors, and treatment of splanchnic vein thrombosis (SVT) in acute pancreatitis (AP).
Methods: All AP admissions between 2018 and 2021 across North East of England were included. Anticoagulation was considered in the presence of superior mesenteric vein/portal vein (SMV/PV) thrombus or progressive splenic vein thrombus (SpVT).
Article Synopsis
- A study analyzed pancreatic cancer patients diagnosed after undergoing a pancreaticobiliary endoscopic ultrasound (EUS) that initially did not detect the cancer, identifying that 6.5% of patients fell into this "post-EUS pancreatic cancer" (PEPC) category.
- Factors linked with PEPC included older age (≥75 years), higher co-morbidity scores, chronic pancreatitis, and diabetes mellitus, while the use of metal biliary stents and EUS-fine needle aspiration were found to decrease the risk of PEPC.
- Patients with PEPC had a higher 1-year mortality rate (hazard ratio 1.12) with only 14% undergoing surgical resection compared to
Objective: The diagnostic performance of endoscopic ultrasound (EUS) for stratification of head of pancreas and periampullary tumours into resectable, borderline resectable and locally advanced tumours is unclear as is the effect of endobiliary stents. The primary aim of the study was to assess the diagnostic performance of EUS for resectability according to stent status.
Design: A retrospective study was performed.
Background: The optimal analgesic strategy for patients with acute pancreatitis (AP) remains unknown.
Objective: The present systematic review and meta-analysis aims to compare the efficacy of different analgesic modalities trialled in AP.
Methods: A systematic search of PubMed, MEDLINE, EMBASE, CENTRAL, SCOPUS and Web of Science conducted up until June 2021, identified all randomised control trials (RCTs) comparing analgesic modalities in AP.
Population-level data on the outcomes of pancreaticobiliary endoscopic ultrasound (PB-EUS) are limited. We examined national PB-EUS and fine-needle aspiration (FNA) activity, its relation to pancreatic cancer therapy, associated mortality and adverse events. Adults undergoing PB-EUS in England from 2007-2016 were identified in Hospital Episode Statistics.
View Article and Find Full Text PDFThe basal-like molecular subtype of pancreatic ductal adenocarcinoma (PDAC) is associated with poor prognosis and upregulation in TP63ΔN (p40) network. Adenosquamous histology can be observed. This study assessed immunohistochemical p40 expression in fine needle biopsy (FNB) samples with PDAC and association with cytomorphological features of squamous differentiation and clinical data.
View Article and Find Full Text PDFBackground And Aims: EUS-guided choledochoduodenostomy (EUS-CDD) with an electrocautery-enhanced lumen-apposing metal stent (EC-LAMS) has emerged as a viable method of establishing biliary drainage in patients with malignant distal biliary obstruction (MDBO). Our aim was to assess the efficacy, safety, and outcomes in patients with MDBO who underwent EUS-CDD with an EC-LAMS.
Methods: A retrospective review of consecutive patients with MDBO who underwent EUS-CDD with EC-LAMSs at 8 tertiary institutions across the United Kingdom and Ireland between September 2016 and November 2020 was undertaken.