Rakesh Kochhar

Postgraduate Institute of Medical Education and Research | PGIMER · Department of Gastroenterology

Antiplatelet and/or anticoagulant agents (collectively known as antithrombotic agents) are used to reduce the risk of thromboembolic events in patients with conditions such as atrial fibrillation, acute coronary syndrome, recurrent stroke prevention, deep vein thrombosis, hypercoagulable states and endoprostheses. Antithrombotic-associated gastroin...

Background Gastric varices (GVs) are conventionally managed with endoscopic cyanoacrylate (E-CYA) glue injection. Endoscopic ultrasound (EUS)-guided therapy using combination of coils and CYA glue (EUS-CG) is a relatively recent modality. There is limited data comparing the two techniques. Methodology This international multicentre study include...

This review summarized the current controversies in the management of acute pancreatitis (AP). The controversies in management range from issues involving fluid resuscitation, nutrition, the role of antibiotics and antifungals, which analgesic to use, role of anticoagulation and intervention for complications in AP. The interventions vary from perc...

Background: Multisystem organ failure (MSOF) is the most important determinant of mortality in acute pancreatitis (AP). Obesity and alcoholic etiology have been examined as potential risk factors for MSOF, but prior studies have not adequately elucidated their independent effects on the risk of MSOF. Objective: We aimed to determine the adjusted...

Purpose It is recommended to drain the pancreatic fluid collections later in the course of the acute necrotizing pancreatitis (ANP). However, earlier drainage may be indicated. We compared early (≤ 2 weeks) vs. late (3rd to 4th week) percutaneous catheter drainage (PCD) of acute necrotic collections (ANC). Materials and methods This retrospective...

Background Proton pump inhibitors (PPI) may impact the absorption of vitamin B12. We performed a systematic review to ascertain if PPI use increases risk of vitamin B12 deficiency. Methods Electronic databases (Pubmed, Embase, Scopus) were searched on first of September 2022. We selected studies that compared the frequency of vitamin B12 deficienc...

Background: Emergence of drug resistance, especially to second-line drugs, hampers tuberculosis elimination efforts. The present study evaluated MTBDRplus and MTBDRsl assays for detecting first-line and second-line drug resistance, respectively in gastrointestinal tuberculosis (GITB). Methods: 30 ileo-caecal biopsy specimens, processed in the De...

Background Predicting response to biliary drainage is critical to stratify patients with acute cholangitis. Total leucocyte count (TLC) is one of the criteria for predicting the severity of cholangitis and is routinely performed. We aim to investigate the performance of neutrophil-lymphocyte ratio (NLR) in predicting clinical response to percutaneo...

Background Timely intervention can alter outcome in patients of infected pancreatic necrosis (IPN) but lacks adequate biomarker. Role of serum procalcitonin (PCT) in the management of IPN is understudied, and hence, this study was planned. Methodology All patients of acute pancreatitis with IPN without prior intervention were included. Baseline dem...

Purpose To assess the correlation between abdominal fat measured at computed tomography (CT) and dual-energy X-ray absorptiometry (DXA) and association with clinical outcomes in patients with acute pancreatitis (AP). Methods This prospective study comprised consecutive patients with AP who underwent abdominal CT and DXA. Fat estimation was done on...

Background Mesenteric changes in acute pancreatitis (AP) are understudied and not accounted for in the current CT-based classification. This study aimed to evaluate and propose a new CT-based classification defining mesenteric changes and their predictive capability on the outcome. Methods The CT films of all consecutive moderately severe/severe A...

Background Limited data suggest that a gluten-free diet (GFD) alone can improve bone mineral density in patients with celiac disease (CeD) and vitamin-D deficiency without the need for Vit-D supplementation. This study aimed at comparing the effects of additional Vit-D supplementation to GFD in newly diagnosed CeD with Vit-D deficiency. Methods Al...

Background Endoscopic dilation is the preferred initial management strategy for caustic-induced esophageal strictures (ES). However, the differences in the outcome of different dilators are not clear. Methods Between January 1998 and December 2016, data of all the patients with caustic-induced ES was retrieved. Data collected included demographic...

Background Pain in acute pancreatitis (AP) can be managed by both opioids and non-steroidal anti-inflammatory drugs (NSAIDs), but evidence-based recommendations are lacking. This study aimed at comparing the efficacy of diclofenac, an NSAID with Buprenorphine, an opioid for pain relief in AP. Methods In this double-blinded randomized controlled tr...

Background Patients with moderate–severe cholangitis require urgent/early biliary drainage and failed endoscopic retrograde cholangiopancreatography (ERCP) warrants use of percutaneous drainage. While endoscopic ultrasound-guided biliary drainage (EUS-BD) has evolved as an effective salvage modality but its safety and efficacy data in moderate–seve...

Purpose Critically ill patients with acute pancreatitis (AP) require intensive care unit (ICU) admission. The management of pancreatic fluid collections (PFCs) in this group is challenging. We aimed to evaluate the feasibility and safety of bedside percutaneous ultrasound (USG)-guided interventions in necrotic PFC in ICU patients. Methods This retr...

Moderately severe and severe acute pancreatitis is characterized by local and systemic complications. Systemic complications predominate the early phase of acute pancreatitis while local complications are important in the late phase of the disease. Necrotic fluid collections represent the most important local complication. Drainage of these collect...

Aim To investigate the performance of T2-weighted abbreviated magnetic resonance imaging (T2W-AMRI) protocol in evaluating patients with acute necrotizing pancreatitis (ANP). Methods A retrospective analysis of consecutive hospitalized patients with ANP who underwent MRI (contrast-enhanced, CE or non-contrast, NC) between January 2017 and November...

Background Acute pancreatitis remains the most common and morbid complication of endoscopic retrograde cholangiopancreatography (ERCP). The use of rectal indomethacin and pancreatic duct stenting has been shown to reduce the incidence and severity of post-ERCP pancreatitis (PEP), but these interventions have limitations. Recent clinical and transla...

Objectives: The intestinal permeability (IP) of sugars and their derivatives has been widely used to assess mucosal damage in gastrointestinal diseases. Ulcerative colitis (UC) is a recurring and relapsing disease that causes inflammation of the gut. IP of sugars can be evaluated and correlated with the flare of UC. Materials and methods: A pros...

Aim: To systematically investigate the timing of encapsulation of necrotic collections in acute necrotizing pancreatitis (ANP) using contrast-enhanced computed tomography (CECT). Methods: This retrospective study comprised consecutive patients of ANP who underwent CECT of the abdomen between the second and fourth weeks of illness. Number and site o...

Objective To evaluate the role of contrast-enhanced ultrasound (CEUS) in the differential diagnosis of solid pancreatic head lesions (SPHL). Methods This prospective study comprised consecutive patients with SPHL who underwent CEUS evaluation of the pancreas. Findings recorded at CEUS were enhancement patterns (degree, completeness, centripetal enh...

Purpose To compare the success rate, clinical outcomes, and complications of retroperitoneal (RP) versus transperitoneal (TP) percutaneous catheter drainage (PCD) of the necrotic pancreatic fluid collections. Materials and methods This retrospective study comprised consecutive patients with acute pancreatitis who underwent PCD of lesser sac collec...

Background: Prompt and accurate diagnosis of Gastrointestinal tuberculosis (GITB) along with simultaneous detection of drug resistance are inevitable for tuberculosis elimination. Truenat MTB Plus (TruPlus), a chip-based real-time polymerase chain reaction assay was evaluated for the first time for diagnosing GITB and detecting rifampicin resistan...

Caustic ingestion can lead to structural changes in the upper gastro-intestinal tract. However, there is limited data on the effect of caustic ingestion on gastric secretion. This study was planned to determine changes in gastric acid output after sham feeding in patients with caustic induced esophageal stricture and to compare it with healthy cont...

Purpose Gastrointestinal (GI) manifestations have been well documented in patients with coronavirus disease 2019 (COVID-19), but its clinical impact on the course of the disease is debatable. Majority of the available data is retrospective, and hence this prospective study was planned to study the impact of GI symptoms on COVID-19 outcome. Methods...

Preoperative biliary drainage (PBD) was primarily introduced to reduce perioperative complications following hepato-pancreato-biliary surgeries. There is no proper consensus on the routine use of PBD before pancreaticoduodenectomy (PD). This is a prospective observational study of patients who underwent PD between July 2013 and December 2014. The s...

Background: Comparative data on percutaneous catheter drainage (PCD) vs EUSguided drainage (EUS-D) for management of symptomatic walled-off-necrosis (WON), specially infected WON with/ without organ failure(OF) is limited and hence this study was planned. Methods: Patients with symptomatic WON were divided into two groups of PCD and EUS-D, dependin...

Background: Endoscopic ultrasound (EUS)-guided drainage is the preferred treatment of pancreatic fluid collections (PFC). However, the choice of the stent for EUS-guided drainage in critically ill PFC cases with infected walled-off necrosis (WON) and/or organ failure (OF) remains unknown. Materials and methods: Between January 2018 and December 20...

Background: Caustic-induced gastric outlet obstruction (GOO) remains one of the important causes of long-term morbidity in patients with caustic ingestion. Though endoscopic balloon dilation is an effective modality, response to caustic GOO is poorer as compared to peptic stricture. Computed tomography (CT)-antral wall thickness (AWT) has not been...

Background and Aims Although abdominal pain is one of the major criteria to diagnose acute pancreatitis (AP), there are no standardized guidelines to treat this troublesome symptom in the hospital setting. The aims of the study are to conduct a meta-analysis and to assess the efficacy of nonopioids vs opioids for pain management in AP. Methods We...

Background and Aim: With the advent of the technique of sub-mucosal tunnelling, peroral endoscopic myotomy (POEM) has been used for the treatment of esophageal diverticulum, which otherwise is a recurring problem with conventional flexible endoscopic treatment due to incompleteness of septotomy. This study reports our experience of the use of diver...

Background SARS-CoV-2 can cause acute pancreatitis (AP) and virus superinfection can occur during prolong hospitalisation. Our objective was to characterize SARS-CoV-2 related AP and study the impact of SARS-CoV-2 superinfection on outcomes in AP. Methods In this multicentre prospective study, all patients with AP plus SARS-CoV-2 infection between...

Background The varied presentation of celiac disease (CD) makes it challenging to diagnose it and predisposes to a significant diagnostic delay. We undertook a study to evaluate the effect of delayed diagnosis of CD on its systemic and laboratory manifestations. Methods In this retrospective analysis of prospectively collected data (January 2015 to...

Background: Early prediction of response to percutaneous catheter drainage (PCD) of necrotic collections in acute pancreatitis (AP) using simple and objective tests is critical as it may determine patient prognosis. The role of white blood cell (WBC) count and neutrophil-lymphocyte ratio (NLR) has not been assessed as a tool of early prediction of...

Background The prevalence of AP in pregnancy (APIP) is uncertain with varying reports of its impact on maternal and foetal outcomes. Objectives This study was aimed to find the prevalence of APIP and its effect on the maternal and foetal outcomes. Search strategy Electronic databases were searched upto 31.05.2020 for the appropriate studies. Sel...

Percutaneous endoscopic gastrostomy (PEG) is one of the most commonly performed endoscopic procedures and a first-line treatment for the establishment of enteral access in those with intolerance or contraindication to oral feedings. A small amount of pneumoperitoneum in the immediate postprocedure period is well reported after PEG tube placement. H...

Introduction Postoperative pancreatic fistula is a dreaded complication following pancreatic head resections. There are many variables which predict occurrence of pancreatic fistula we analysed the anatomical factors at the pancreatic transection to predict occurrence of pancreatic fistula. Materials and methods It is a prospective observational st...

Objectives: Organ failure (OF) and infected necrosis (IN) are the most important predictors of mortality in necrotizing acute pancreatitis (AP). We studied the relationship between timing (onset and duration) and patterns of OF with mortality and the impact of IN on mortality. Methods: Consecutive patients with necrotizing AP between January 2017...

Background/Objectives The relationship between pre-existing diabetes mellitus (DM) and acute pancreatitis (AP) severity has not been established. We assessed the impact of pre-existing DM on AP severity in an international, prospectively ascertained registry. Methods APPRENTICE registry prospectively enrolled 1543 AP patients from 22 centers acros...

Background: There is an emerging role of fungal dysbiosis in the pathogenesis of inflammatory bowel disease. Prevalence of Candida in patients with active ulcerative colitis (UC) and the effect of fluconazole therapy in reducing disease activity of UC are not known. Patients and methods: All consecutive consenting patients with active UC defined...

Background: There is limited literature on the role of percutaneous transhepatic biliary drainage (PTBD) as an adjunct to endoscopic retrograde cholangiopancreatography (ERCP). This study evaluates the role of PTBD in patients with failed ERCP or post-ERCP cholangitis. Methods: Retrospective evaluation of clinical and intervention records of patien...

Background and aims: The aims of this study were to: 1) assess the performance of the pancreatitis activity scoring system (PASS) in a large intercontinental AP cohort, 2) investigate whether a modified PASS, yields a similar predictive accuracy and produces distinct early trajectories between severity subgroups. Methods: Data was prospectively...

In summary, we report on the testing of a new digital tool designed to support physicians caring for patients with AP using the APPRENTICE cohort

Background The presence of necrotic collection in acute necrotizing pancreatitis (ANP) at intra-abdominal sites other than the retroperitoneum has not been systematically studied.AimTo investigate unusual sites of necrotic collections at computed tomography (CT) and to evaluate association with pancreatic necrosis and clinical outcomes.Methods This...

The Indian Association of Pathologists and Microbiologists (IAPM) and Indian Society of Gastroenterology (ISG) decided to make a joint consensus recommendation for handling, processing, and interpretation of SI biopsies for the diagnosis and management of celiac disease (CD) recognizing the inhomogeneous practice of biopsy sampling, orientation, pr...

Background Non-steroidal anti-inflammatory drugs (NSAIDs), intravenous fluid, pancreatic stents, or combinations of these have been evaluated in randomised controlled trials (RCTs) for the prevention of post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis, but the comparative efficacy of these treatments remains unclear. Our aim...

Ectopic varices, defined as dilated portosystemic veins located at unusual sites other than the gastroesophageal junction and fundus, have been reported in cases of cirrhosis with underlying portal hypertension. The common sites usually are the rectum and duodenum. Isolated colon varix is therefore a rare phenomenon and such varix presenting with l...

Purpose Intraabdominal hypertension (IAH) in acute pancreatitis (AP) may reduce tissue perfusion and impair organ function and has been shown to portend poor prognosis. We investigated the computed tomography (CT) findings in patients with AP with IAH. Methods This retrospective study comprised of consecutive patients with AP from June 2016 to June...

Purpose To evaluate the safety and feasibility of bedside percutaneous transhepatic biliary drainage (PTBD) as a salvage procedure in patients with severe cholangitis in the intensive care unit (ICU). Methods This retrospective study evaluated records of consecutive patients with severe cholangitis who were admitted in the ICU. Bedside PTBD was pe...

Esophagorespiratory fistula in adults as a result of corrosive ingestion is a rare occurrence and is a difficult problem to manage. Three young (15-19 years) patients (2F, 1M) out of 115 (incidence 2.6 %) of corrosive ingestion who had tracheoesophageal fistula (TEF) were reviewed retrospectively. After initial management, enteral route of nutritio...

Duodenal involvement in colonic malignancy is a rare event and poses challenge to surgeons as it may entail major resection in a malnourished patient. Nine patients with malignant colo-duodenal fistula were reviewed retrospectively. Depending on the pattern of duodenal involvement, it was classified as-type I involving lateral duodenal wall less th...

Background and Aim Severe acute pancreatitis (SAP) is commonly associated with intra‐abdominal hypertension (IAH). This acute increase of intra‐abdominal pressure (IAP) may be attributed to early organ dysfunction, leading to an increased morbidity and mortality. To assess the incidence of raised IAH and its correlation with other prognostic indica...

Inflammatory bowel disease (IBD), once considered a disease of the Western hemisphere, has emerged as a global disease. As the disease prevalence is on a steady rise, management of IBD has come under the spotlight. 5-Aminosalicylates, corticosteroids, immunosuppressive agents and biologics are the backbone of treatment of IBD. With the advent of bi...

Purpose The existing CT indices do not allow quantitative prediction of clinical outcomes in acute pancreatitis (AP). The aim of this study was to develop and validate a revised CT index using a nomogram-based approach. Methods This retrospective study comprised consecutive patients with AP who underwent contrast-enhanced CT between June 2017 and...