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Gottumukkala S Raju

Publications and source records attributed to Gottumukkala S Raju.

At least 19 recordsLinked to original sources
PubMed2007

Suprapapillary puncture of the common bile duct for selective biliary access: a novel technique (with videos).

BACKGROUND: Selective cannulation of the bile duct while avoiding the potential mechanisms that initiate the cascade of pancreatic injury may prevent or minimize post-ERCP pancreatitis. This could be accomplished by suprapapillary needle puncture of the bile duct with a specially designed needle. OBJECTIVES: The aim of this study is to describe a new technique to perform selective biliary cannulation by using a novel needle-puncture device and its outcome in 28 patients with suspected biliary pathology. DESIGN: This is a single-center, prospective pilot study of suprapapillary puncture of bile duct for both diagnosis and therapy of biliary pathology. SUBJECTS: Thirty patients were enrolled: 28 patients underwent suprapapillary puncture to gain biliary access, and 2 patients with a large periampullary diverticulum were excluded. INTERVENTIONS: After successful biliary cannulation by using a suprapapillary puncture technique and balloon dilation of the tract if necessary, stone removal, plastic stent insertion, and metal stent insertion were attempted. MAIN OUTCOME MEASUREMENTS: Successful biliary cannulation, time for cannulation, outcome of therapy (clearing the stones or providing stent drainage with stent insertion), and complications were recorded. At 60 days, the suprapapillary puncture was evaluated to check the status of drainage. RESULTS: Suprapapillary puncture was successful in 25 of the 28 patients, and, in 1 patient, it was successful after a week. It was useful in demonstrating a normal bile duct in 9 of 11 patients with suspected biliary pathology. Subsequent therapy was successful in the management of 11 patients with stones, benign biliary pathology in 2 patients, and malignant biliary pathology in 3 of 4 patients. None of the patients developed post-ERCP pancreatitis. Complications included small perforations that resolved with conservative management (n = 2), minor bleeding (n = 2), and submucosal injection (n = 1). At 60 days, all the puncture sites healed in patients who did not undergo dilation, while those with dilation of the tract had a patent orifice, with excellent flow of bile. CONCLUSIONS: Suprapapillary puncture for biliary cannulation is a useful technique for selective cannulation of the bile duct and avoids injury to the pancreas but with higher complication rates. Further studies will be needed to define its safety and its relative benefits compared with conventional access methods.

Aged↗
PubMed2006

High-frequency probe ultrasonography has limited accuracy for detecting invasive adenocarcinoma in patients with Barrett's esophagus and high-grade dysplasia or intramucosal carcinoma: a case series.

AIM: To evaluate prospectively the accuracy of preoperative high-frequency (20 MHz) probe ultrasonography (HFPUS) for detecting invasive cancer in patients referred for esophagectomy because of an endoscopic biopsy diagnosis of high-grade dysplasia (HGD) or intramucosal carcinoma (ICA) in Barrett's esophagus (BE). PATIENTS AND METHODS: Nine consecutive male patients (median age of 69 yr) who were referred for esophagectomy for HGD or ICA in BE agreed to participate. We performed conventional upper gastrointestinal endoscopy followed by HFPUS using a through-the-scope ultrasound probe (20 MHz), and we compared our preoperative findings with the pathologist's findings in the resected esophageal specimens. RESULTS: There was complete agreement between the postoperative pathological findings and the preoperative HFPUS findings in only 4 of the 9 patients. HFPUS resulted in two false-negative diagnoses of esophageal cancer (both had T1 lesions in the resected specimens), one false-positive diagnosis of esophageal cancer, and two errors in tumor staging (1 understaged, 1 overstaged). CONCLUSIONS: HFPUS has limited accuracy for identifying invasive cancer in patients found to have HGD or IMC in BE. Pending further refinements in technology, clinical management decisions in such patients should not be based solely on the results of HFPUS.

Adenocarcinoma↗
PubMed2006

Endoluminal closure of large perforations of colon with clips in a porcine model (with video).

BACKGROUND: Endoluminal clip closure of small perforations of the colon is possible. It is unclear whether large perforations of the colon can be closed with clips deployed through a colonoscope. OBJECTIVES: To evaluate the technical feasibility and outcome of endoluminal closure of large perforations of the colon with clips. DESIGN: Pilot study. SUBJECTS: Eight pigs. INTERVENTIONS: Endoluminal clip closure of large perforations of the colon. MAIN OUTCOME MEASUREMENTS: Technical feasibility of endoluminal closure was evaluated in 8 animals. A dye leak test was performed to evaluate quality of endoluminal sealing immediately after closure and 2 weeks after closure. The animals in the survival group were monitored daily for 2 weeks for sepsis and peritonitis. Necropsy was done on day 14 to check for fecal peritonitis, wound dehiscence, and histological healing of perforation. RESULTS: Endoscopic closure of colon perforation was successful in 6 of 8 animals; in 2 animals closure was unsuccessful due to prolapse of adjacent viscera into the colon (n = 1) and severe bleeding that obscured the view (n = 1). There was a leak-proof sealing of the perforation site in 2 animals tested immediately and in all the animals tested (n = 3) 2 weeks after closure. All 4 animals in the survival group recovered well, without any sepsis or peritonitis. Necropsy did not reveal fecal peritonitis or pericolonic abscess formation. The perforation site demonstrated a thin scar and there was histological healing. CONCLUSIONS: Endoluminal application of clips is successful in the closure of a large perforation of the colon in a porcine model.

Animals↗
PubMed2006

Biliary drainage by using stents without a central lumen: a pilot study.

BACKGROUND: Despite several attempts to make the conventional tubular stents with a central lumen for flow less susceptible to a biofilm buildup and thereby prevent clogging, this goal has remained elusive. We hypothesized that the creation of pathways for fluid flow around the stent instead of through it would avoid this problem. The aim of our study was to report the development and the evaluation of a novel lumen-less stent. METHODS: By using a software computer modeling, a 10F "winged" stent was designed. A pilot feasibility study was performed by using a prototype of this stent for endoscopic biliary drainage in 5 patients with malignant biliary obstruction. OBSERVATIONS: Modeling data revealed that the winged stent offers a larger surface area for flow, higher velocity of flow, and increased flow rates compared with the conventional tubular stent. In the clinical trial, there was a significant decrease of serum bilirubin after the placement of this stent (serum bilirubin before and 2 weeks after stent placement, 14.94 +/- 5.7 mg/dL vs. 2.86 +/- 1.4 [p < 0.004]), accompanied by radiologic evidence of decompression of the biliary system. CONCLUSIONS: We have shown that it is possible to provide adequate biliary drainage by using a stent without a lumen. Such a design may have potential clinical advantages over existing designs.

Aged↗
PubMed2006

Immediate endoscopic closure of colon perforation by using a prototype endoscopic suturing device: feasibility and outcome in a porcine model (with video).

BACKGROUND: Perforation is an uncommon but potentially devastating complication of colonoscopy. Surgical closure is the standard of care. Immediate endoluminal closure of a perforation would avoid the morbidity and mortality associated with general anesthesia, laparotomy, and surgical repair. OBJECTIVES: To evaluate the feasibility and safety of full-thickness endoscopic closure of colonic perforations with a prototype endoscopic suturing device, the Eagle Claw, in a porcine model. DESIGN: Endoscopic animal experimental study of closure of colon perforation by using a porcine model. SUBJECTS: Ten pigs were included in the study. INTERVENTIONS: The Eagle Claw was used to close small perforations (1.5 to 2 cm) of the colon created by needle-knife with the animal under general anesthesia by using the endoluminal route. All animals received intravenous antibiotics and were allowed to eat after 24 hours. MAIN OUTCOME MEASUREMENTS: The animals were monitored daily for signs of sepsis and peritonitis. On day 7, they were euthanized. The peritoneal cavity was examined for fecal peritonitis, and the colon perforation site was checked for wound dehiscence and pericolic abscess formation. RESULTS: Endoscopic closure of the colon perforation was successful in 7 animals, and they recovered well without any sepsis or peritonitis. Necropsy did not reveal fecal peritonitis or pericolonic abscess formation at the site of perforation, and the perforation healed well. Closure was successful in 1 animal, but necropsy revealed dehiscence of the colon perforation site. Endoscopic closure was unsuccessful in 2 animals, and these were euthanized immediately. CONCLUSIONS: Closure of acute perforation of the colon is feasible with the Eagle Claw endoscopic suturing device in a porcine model.

Animals↗
PubMed2006

Controlled trial of immediate endoluminal closure of colon perforations in a porcine model by use of a novel clip device (with videos).

BACKGROUND: Although endoluminal closure of a small perforation of the colon is technically feasible, the outcome of such a closure is unclear. OBJECTIVE: Our purpose was to evaluate the feasibility and the outcome of endoluminal closure of a small perforation of the colon with a novel clip device, the InScope MultiClip Applier (IMCA), and to assess the number of clips required for successful closure. DESIGN: Prospective controlled study. SETTING: University hospital. ANIMALS: 17 pigs. INTERVENTIONS: A 2-cm full-thickness colon perforation was randomized to 3 groups: control, no closure (n = 4), 2-clip closure (n = 7), and 4-clip closure (n = 6). MAIN OUTCOME MEASUREMENTS: (1) Technical feasibility of closure, (2) closure time, (3) clinical monitoring for 2 weeks, (4) necropsy (day 14), and (5) healing by a dye leak test and histologic examination. RESULTS: Endoscopic closure of the colon perforation was technically successful in 12 of 13 animals. A wide gaping hole prevented satisfactory closure in 1 animal. The median time for closure with 2 and 4 clips was 2 and 3 minutes, respectively. Clip closure of perforation prevented clinical sepsis (P = .008) and diminished the risk for fibrinous peritonitis (P = .02 for a single test of hypothesis; however, correction for the multiple testing of data removes this significance) and adhesion formation (P = .008) compared with controls, without any leakage. The outcomes of 2- and 4-clip closure were similar. CONCLUSIONS: Endoluminal closure of a 2-cm colon perforation with clips is successful in preventing peritonitis and adhesions and it can be accomplished quickly with this novel device. Clip closure at 1-cm intervals is sufficient for successful closure of a 2-cm colon perforation.

Animals↗
PubMed2006

Surgery or endoscopy for palliation of biliary obstruction due to metastatic pancreatic cancer.

BACKGROUND AND AIMS: Both endoscopic and surgical drainage procedures are effective palliative methods for malignant biliary obstruction. Surgical drainage is still preferred in developing countries due to the high cost of procuring metal biliary stents. The aim of this study was to evaluate the quality of life and the cost of care in patients with metastatic pancreatic cancer after endoscopic biliary drainage and surgical drainage. PATIENTS AND METHODS: This is a prospective, randomized controlled trial conducted in a tertiary referral center in Brazil. Patients with biliary obstruction due to metastatic pancreatic cancer and liver metastasis, but without gastric outlet obstruction, were included in the study. Endoscopic biliary drainage with the insertion of a metal stent into the bile duct was compared with the surgical drainage procedure (choledochojejunostomy and gastrojejunostomy). Quality of life was assessed before, and 30 days, 60 days, and 120 days after the drainage procedure. The cost of drainage procedure, cost during the first 30 days and the total cost from drainage procedure to death were calculated. RESULTS: Of the 273 patients with pancreatic malignancy seen at our hospital between July 2001 and October 2004, 35 patients were eligible for the study, and 30 agreed to participate in the study. Both surgical and endoscopic drainage procedures were successful, without any mortality in the first 30 days. The cost of biliary drainage procedure (US dollars 2,832 +/- 519 vs 3,821 +/- 1,181, p= 0.031), the cost of care during the first 30 days after drainage (US dollars 3,122 +/- 877 vs 6,591 +/- 711, p= 0.001), and the overall total cost of care that included initial care and subsequent interventions and hospitalizations until death (US dollars 4,271+/- 2,411 vs 8,321 +/- 1,821, p= 0.0013) were lower in the endoscopy group compared with the surgical group. In addition, the quality of life scores were better in the endoscopy group at 30 days (p= 0.042) and 60 days (p= 0.05). There was no difference between the two groups in complication rate, readmissions for complications, and duration of survival. CONCLUSIONS: Endoscopic biliary drainage is cheaper and provides better quality of life in patients with biliary obstruction and metastatic pancreatic cancer.

Cholangiopancreatography, Endoscopic Retrograde↗
PubMed2005

A pilot study of endoscopic closure of colonic perforations with endoclips in a swine model.

BACKGROUND: Surgical closure of a colon perforation is accompanied by the risks of general anesthesia and prolonged recovery from surgery because of ileus and other sequelae. Very little is known about the effectiveness of endoluminal repair of colon perforations with clips, which eliminates incisions of the abdominal wall and provides a less invasive alternative to surgical closure. The aim of this study is to evaluate the feasibility and the safety of endoscopic closure of colonic perforations with endoclips in a porcine model. METHODS: Approximately 1.5- to 2-cm colon perforations created with a needle knife in 4 50-kg, female pigs that were under general anesthesia were closed with endoclips. After 24 hours of recovery, the animals were allowed to eat. All the animals received intravenous antibiotics and were carefully monitored for signs of sepsis. After a follow-up of 1 week, the pigs were euthanized for postmortem examination. The fifth pig was euthanized immediately after closure of a 5-cm colon perforation with clips to evaluate the extent of transmural closure with endoclips. RESULTS: The animals recovered well, without any clinical features of sepsis or peritonitis. Postmortem examination did not reveal fecal peritonitis, and there was no evidence of pericolonic abscess formation at the site of perforation. The perforation site showed signs of healing without any evidence of transmural dehiscence. Histopathology demonstrated granulation tissue bridging the site of perforation. In the fifth pig, euthanized immediately after closure of the perforation, nice mucosal apposition was seen, while the muscular and serosal coats remained dehisced. CONCLUSIONS: Endoscopic closure of small iatrogenic colon perforations with clips results in mucosal and submucosal healing and prevents fecal soiling of peritoneal cavity.

Animals↗
PubMed2005

Insertability and safety of a shape-locking device for colonoscopy.

BACKGROUND: Loop formation during colonoscopy insertion results in patient pain and delays in advancement of the colonoscope tip. AIM: To assess the insertability and safety of a novel shape-locking guide (ShapeLock, USGI, San Clemente, CA) that resists looping during colonoscopy. RESULTS: In 54 patients, both a disposable and a partly reusable version of the ShapeLock received high scores (mean scores >9.0 on 1-10 scale) for ease of insertion, and ability to maneuver the colonoscope through the shape locked device. No significant trauma resulted from use of the device. CONCLUSION: A novel shape-locking device for colonoscopy can be readily and safely inserted into the colon and locked. The device warrants controlled evaluation to determine in which, if any cases, it may be useful for either experienced colonoscopists and/or those with less or minimal experience.

Adult↗