Biomedical subjects

Rig S Patel

Publications and source records attributed to Rig S Patel.

4 recordsLinked to original sources

PubMed2005

Post-sphincterotomy bleeding after the introduction of microprocessor-controlled electrosurgery: does the new technology make the difference?

BACKGROUND: Bleeding as a complication of endoscopic sphincterotomy is influenced by several factors. The objective of this study was to compare rates of bleeding after sphincterotomy performed with two different electrosurgical current generators (Valleylab SSE2L and ERBE ICC200). METHODS: A total of 6179 consecutive reports of ERCP were analyzed to compare the frequency of endoscopically and clinically evident bleeding after sphincterotomy when using the Valleylab SSE2L generator (from February 1994 to November 1997) and the ERBE ICC200 generator (from December 1997 to September 2000). Relevant risk factors were assessed by univariate analysis and significant predictors were included in a multiple logistic regression model. RESULTS: A total of 2711 sphincterotomies were performed in 2309 patients (1749 biliary, 962 pancreatic). Endoscopically observed bleeding occurred in 68 patients (5.5%) in the ValleyLab group and 13 (1.2%) in the ERBE group. The ValleyLab generator was independently associated with an increase in endoscopically observed bleeding (OR 4.02: 95% CI[2.13, 7.61], p <0.001). There was no significant difference in clinically evident bleeding between the two groups. CONCLUSIONS: Use of the microprocessor-controlled ERBE electrosurgical generator for endoscopic sphincterotomy was associated with a significantly lower frequency of endoscopically observed bleeding but not clinically evident bleeding.

Adult↗

PubMed2005

The yield and the predictors of esophageal pathology when upper endoscopy is used for the initial evaluation of dysphagia.

BACKGROUND: The utility of EGD when used as an initial test for the evaluation of dysphagia is unclear. The objective was to determine the yield and the predictive factors of significant pathology when EGD is performed as the initial test to evaluate dysphagia. METHODS: This is a retrospective analysis of a computerized database. Data on patients who underwent EGD for dysphagia were retrieved from the endoscopy database of 6 endoscopy units. Patients who had undergone prior esophageal evaluation, failed EGD, or who had a history of prior upper-GI pathology were excluded. Univariate and multivariable logistic regression analyses were performed to evaluate any relation between endoscopic findings and presenting clinical features. RESULTS: A total of 1649 patients with dysphagia (mean age 56.7 years, standard deviation 16.4; M:F 3:2) were analyzed. Abnormal findings at EGD were found in 70% (1150) of the patients, and a major pathology was seen in 54% (898). Male gender (p=0.0001), heartburn (p=0.0007), and odynophagia (p=0.0001) predicted the presence of major pathology. Cancer was found in 4% (70) of patients and was predicted by male gender (p=0.0002), age (p=0.01), and weight loss (p=0.04). The esophagus was normal in 29% (483) of patients and was predicted by female gender (p=0.0001) and the absence of heartburn (p=0.0004) but not age. There was a lack of details on patients' presentation and clinical history and an absence of long-term clinical follow-up. CONCLUSIONS: EGD is an effective and an appropriate tool for the initial evaluation of patients presenting with dysphagia. Early EGD should be considered, particularly, in male patients aged more than 40 years old who concomitantly report heartburn, odynophagia, or weight loss.

Abdominal Pain↗

PubMed2003

Effects of gender and age on esophageal biomechanical properties and sensation.

OBJECTIVES: The effects of gender and age on human esophageal function is poorly defined. Our aim was to investigate the sensory perception and the biomechanical properties of the esophagus both at the smooth muscle and the striated muscle segments in age- and gender-matched healthy subjects. Eleven older individuals (five men and six women, aged 55-82 yr) and 11 younger healthy individuals (five male and six female, aged 22-45 yr) participated in this study. METHODS: Graded balloon distentions were performed at the striated muscle and the smooth muscle segments of the esophagus in a random order using impedance planimetry. Impedance planimetry facilitated simultaneous assessments of the biomechanical properties and sensory perception. RESULTS: We found that both at the striated and smooth muscle segments, the cross-sectional area, circumferential wall tension-strain relationship and the sensory thresholds were similar between men and women. In contrast, at both of these segments, the cross-sectional area was larger (p < 0.05), the circumferential wall tension-strain association had shifted significantly (p < 0.05) to the left (i.e., the wall was stiffer), and the median thresholds for discomfort and pain were higher (p < 0.05) in older subjects. The biomechanical properties and thresholds for sensory perception also varied between the two esophageal segments. CONCLUSIONS: Aging was associated with a larger lumen and a stiffer but less sensitive esophageal wall. Thus, aging but not gender may influence esophageal function.

Adult↗

PubMed2002

Accuracy of EUS for detection of intraductal papillary mucinous tumor of the pancreas.

BACKGROUND: Patients with intraductal papillary mucinous tumors of the pancreas (IPMT) present with symptoms similar to those of chronic pancreatitis. This study assessed the accuracy of EUS for detection of IPMT and identified features that discriminate IPMT from chronic pancreatitis. METHODS: EUS accuracy for detecting IPMT was determined with characteristic findings by endoscopic retrograde pancreatography as the reference standard. To determine EUS features characteristic of IPMT, EUS images from patients with IPMT were compared with those from patients (similar age, gender) with chronic pancreatitis. RESULTS: Thirty-eight patients (23 men, 15 women; age range 40-90 years) with IPMT were identified between 1994 and 2001. For EUS, the sensitivity was 86%, specificity 99%, positive predictive value 78%, and negative predictive value 99% for detection of IPMT. When compared with patients with chronic pancreatitis, the EUS features of dilation of pancreatic duct (89% vs. 42%, p < 0.0001), cysts (45% vs. 11%, p = 0.002), and pancreatic atrophy (32% vs. 3%, p = 0.002) were more common, whereas parenchymal features of chronic pancreatitis were less common with IPMT (21% vs. 97%, p < 0.0001). By multivariate analysis, the presence of no more than one parenchymal feature of chronic pancreatitis suggested the diagnosis of IPMT (odds ratio 43.84; 95% CI [4.13, 465.74]). CONCLUSIONS: EUS may be useful in the initial evaluation of patients suspected to have IPMT. Paucity of parenchymal features of chronic pancreatitis is important in differentiating IPMT from other causes of chronic pancreatitis.

Adenocarcinoma, Mucinous↗