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| 1 | Endoscopic management of postoperative bile leaks显示文摘BACKGROUND: Significant bile leak as an uncommon complication after biliary tract surgery may constitute a serious and difficult management problem. Surgical management of biliary fistulae is associated with high morbidity and mortality. Biliary endoscopic procedures have become the treatment of choice for management of biliary Gstulae. METHODS: Ninety patients presented with bile leaks after cholecystectomy ( open cholecystectomy in 45 patients, cholecystectomy with common bile duct exploration in 20 and laparoscopic cholecystectomy in 25). The presence of bile leaks was confirmed by ERCP and the appearance of bile in percutaneous drainage of abdominal collections. Of the 90 patients with postoperative bile leaks, 18 patients had complete transaction of the common bile duct by ERCP and were subjected to bilioenteric anastomosis. In the remaining patients after cholangiography and localization of the site of bile leaks. therapeutic procedures like sphinctero-tomy, biliary stenting and nasobiliary drainage ( NBD ) were performed. If residual stones were seen in the common bile duct, sphincterotomy was followed by stone extraction using dormia basket. Nasobiliary drain or stents of 7F size were placed according to the standard techniques. The NBD was removed when bile leak stopped and closure of the fistula confirmed cholangiographically. The stents were removed after an interval of 6-8 weeks. RESULTS: Bile leaks in 72 patients occurred in the cystic duct (38 patients), the common bile duct (30 ), and the right hepatic duct (4). Of the 72 patients with post-operative bile leak, 24 had associated retained common bile duct stones and 1 had ascaris in common bile duct. All the 72 patients were subjected to therapeutic procedures including sphincterotomy with stone extraction followed by biliary stenting (24 patients), removal of ascaris and biliary stenting (1), sphincterotomy with biliary stenting (18), sphincterotomy with NBD (12), biliary stenting alone (12), and NBD alone (5). Bile leaks stopped in all patients at a median interval of 3 days (range 3-16 days) after endoscopic in- terventions. No difference was observed in efficacy and in time for the treatment of bile leak by sphincterotomy with endoprosthesis or endoprosthesis alone in patients with bile leak after surgery. CONCLUSIONS: Post-cholecystectomy bile leaks occur most commonly in the cystic duct and associated common bile duct stones are found in one-third of cases. Endoscopic therapy is safe and effective in the management of bile leaks and fistulae after surgery. Sphincterotomy with endoprosthesis or endoprosthesis alone is equally effective in the management of postoperative bile leak. | Naresh Agarwal Barjesh Chander Sharma Sanjay Garg Rakesh Kumar Shiv K Sarin | 2006 | Hepatobiliary & Pancreatic Diseases International2006，5，2： | 33 |
| 2 | Endoscopic management of acute cholangitis in elderly patients显示文摘AIM: To evaluate clinical presentation, etiology, compli-cations and response to treatment in elderly patients with acute cholangitis.METHODS: Demographics, etiology of biliary obstruc-tion, clinical features, complications and associated systemic diseases of 175 patients with acute cholangitis were recorded. Endoscopic biliary drainage was performed using nasobiliary drain or stent. The complications related to ERCP, success of biliary drainage, morbidity, mortality and length of hospital stay were evaluated. RESULTS: Of 175 patients, 52 aged ≥ 60 years (groupⅠ, age < 60 years; group Ⅱ, age ≥ 60 years) and 105 were men. Fever was present in 38 of 52 patients of group Ⅱ compared to 120 of 123 in groupⅠ. High fever (fever ≥ 38.0℃) was more common in groupⅠ(118/120 vs 18/38). Hypotension (5/123 vs 13/52), altered sensorium (3/123 vs 19/52), peritonism (22/123 vs 14/52), renal failure (5/123 vs 14/52) and associated comorbid diseases (4/123 vs 21/52) were more common in group Ⅱ. Biliopancreatic malignancy was a common cause of biliary obstruction in group Ⅱ (n = 34) and benign diseases in groupⅠ(n = 120). Indications for biliary drainage were any one of the following either singly or in combination: a fever of ≥ 38.0℃ (n = 136), hypotension (n = 18), peritonism (n = 36), altered sensorium (n = 22), and failure to improve within 72 h of conservative management (n = 22). High grade fever was more common indication of biliary drainage in groupⅠand hypotension, altered sensorium, peritonism and failure to improve within 72 h of conservative management were more common indications in group Ⅱ. Endoscopic biliary drainage was achieved in 172 patients (nasobiliary drain: 56 groupⅠ, 24 group Ⅱ, stent: 64 groupⅠ, 28 group Ⅱ) without any significant age related difference in the success rate. Abdominalpain, fever, jaundice, hypotension, altered sensorium, peritonism and renal failure improved after median time of 5 d in 120 patients in groupⅠ(2-15 d) compared to 10 d in 47 patients of group Ⅱ (3-20 d). Normalization of leucocyte count was seen after a median time of 7 d (3-20 d) in 120 patients in groupⅠcompared to 15 d (5-26 d) in 47 patients in group Ⅱ. There were no ERCP related complications in either group. Five patients (carcinoma gallbladder n = 3, CBD stones n = 2) died in group Ⅱ and they had undergone biliary drainage after failure of response to conservative management for 72 h. There was a higher mortality in patients in group Ⅱ despite successful biliary drainage (0/120 vs 5 /52). Length of hospital stay was longer in group Ⅱ patients (16.4 ± 5.6, 7-30 d) than in groupⅠpatients (8.2 ± 2.4, 7-20 d).CONCLUSION: Elderly patients with acute cholangitis have a high incidence of severe cholangitis, concomitant medical illnesses, hypotension, altered sensorium, peritonism, renal failure and higher mortality even after successful biliary drainage. | Naresh Agarwal Barjesh Chander Sharma Shiv K Sarin | 2006 | World Journal of Gastroenterology2006，12，40： | 14 |
| 3 | Critical flicker frequency for diagnosis and assessment of recovery from minimal hepatic encephalopathy in patients with cirrhosis显示文摘BACKGROUND:Minimal hepatic encephalopathy (MHE) impairs quality of life and predicts overt hepatic encephalopathy (HE) in cirrhotic patients.Diagnosis of MHE requires cumbersome tests.Lactulose is effective in the treatment of MHE.This study aimed to evaluate the use of critical flicker frequency (CFF) for the diagnosis of MHE in cirrhotic patients after treatment.METHODS:One hundred and ten patients were evaluated by psychometry (number connection tests A,B or figure connection tests A,B),P300 auditory event related potential (P300ERP),venous ammonia,and CFF for MHE.MHE was diagnosed by abnormal psychometry (>2SD age matched controls) and P300ERP.MHE patients were treated with lactulose for one month.Response was defined by normalization (<2SD of matched controls) of both psychometry and P300ERP.RESULTS:Of the 110 patients [Child Turcott Pugh score A:B:C 39:42:29,(age 41.6±11.6 years,M:F 82:28)],75 (68%) had abnormal results of psychometric tests,and 74 (67%) had prolonged P300ERP.Fifteen (20%) patients with abnormal results of psychometric tests had normal P300ERP.Thus sixty (54.5%) patients were diagnosed as having MHE.After treatment for one month,34 (57%) recovered while 26 (43%) continued to have abnormal resents of psychometric or P300ERP tests.CFF was <39 Hz in 72 (65.4%) patients before treatment and in 20 (33.3%) after treatment.CFF sensitivity,specificity,positive predictive value,negative predictive value,and diagnostic accuracy for the assessment of recovery of MHE were 65%,91%,85%,77% and 80%,respectively.CONCLUSION:CFF is a simple,relatively reliable,and accurate test without any dependence on age or literacy in the diagnosis and assessment of recovery of patients with MHE. | Praveen Sharma Barjesh Chander Sharma Shiv Kumar Sarin | 2010 | Hepatobiliary & Pancreatic Diseases International2010，9，1： | 10 |
| 4 | Combination of pegylated interferon and lamivudine for patients with chronic hepatitis B who have failed treatment显示文摘BACKGROUND: Treatment of chronic hepatitis B (CHB) alone with interferon or lamivudine alone or in combination is effective in only a small proportion of patients. Treatment of patients in whom antiviral therapy fails is challenging. This study was made to determine the efficacy of combined pegylated interferon alpha (peg-IFN) and lamivudine in patients with CHB who had failed to respond to antiviral treatment. METHODS: Twenty patients with CHB proven by liver biopsy, with ALT levels >1.5×ULN,HBV DNA levels>141 500 copies/ml, and previous treatment failure with an adequate regimen were treated with a combination of peg-IFN 1.5μg/kg and lamivudine 100 mg/day for 52 weeks and followed up for a further 24 weeks. Biochemical response was defined as normalization of ALT and DNA response as HBV DNA<141 500 copies/ml. Secondary efficacy measures included HBsAg loss, HBeAg loss and appearance of anti-HBe (in cases of HBeAg-positive patients). RESULTS: Twenty patients were treated, of whom 16 were HBeAg positive. At 52 weeks, normal ALT was seen in 10 (50%) (8 of 16 HBeAg+ and 2 of 4 HBeAg), HBV DNA response in 5 (25%) (5 of 16 in HBeAg+ and none in HBeAg-), and HBeAg loss with appearance of anti-HBe in 5 (31.3%) of the 16 HBeAg positive patients. At 76 weeks, 8 (80%) of the 10 patients with normal ALT at 52 weeks relapsed, with normal ALT only in 2 (10%) (1 of 16 HBeAg+ and 1 of 4 HBeAg-), and all 5 patients who had a DNA response at 52 weeks relapsed at 76 weeks and had no DNA response. HBeAg loss with appearance of anti-HBe was seen in 1 (6.3%) of 16 HBeAg-positive patients. None of the patients lost HBsAg. CONCLUSIONS: The combination of peg-IFN and lamivudine for 52 weeks is not effective for treatment of CHB patients with a failed treatment. New treatment strategies need to be developed. | Shiv K.Sarin Manoj Kumar Syed Hissar Barjesh C.Sharma | 2006 | Hepatobiliary & Pancreatic Diseases International2006，5，3： | 3 |
| 5 | Granulocyte Colony–Stimulating Factor Mobilizes CD34 + Cells and Improves Survival of Patients With Acute-on-Chronic Liver Failure显示文摘 | Vishal Garg Hitendra Garg Arshi Khan Nirupama Trehanpati Ashish Kumar Barjesh Chander Sharma Puja Sakhuja Shiv Kumar Sarin | 2012 | Gastroenterology2012，，3： | 3 |
| 6 | Clinical profile and predictors of mortality in patients of acute-on-chronic liver failure显示文摘 | Hitendra Garg Ashish Kumar Vishal Garg Praveen Sharma Barjesh Chander Sharma Shiv Kumar Sarin | 2011 | Digestive and Liver Disease2011，，2： | 3 |
| 7 | Infliximab monotherapy for severe alcoholic hepatitis and predictors of survival: An open label trial显示文摘 | Praveen Sharma Ashish Kumar Barjesh Chander Sharma Shiv Kumar Sarin | 2009 | Journal of Hepatology2009，，3： | 3 |
| 8 | A randomized controlled trial comparing lactulose, probiotics, and L-ornithine L-aspartate in treatment of minimal hepatic encephalopathy显示文摘 | Vibhu Vibhas Mittal Barjesh Chander Sharma Praveen Sharma Shiv Kumar Sarin | 2011 | European Journal of Gastroenterology & Hepatology2011，，8： | 2 |
| 9 | Hepatic and systemic hemodynamic derangements predict early mortality and recovery in patients with acute‐on‐chronic liver failure显示文摘 | Hitendra Garg Ashish Kumar Vishal Garg Manoj Kumar Ramesh Kumar Barjesh Chander Sharma Shiv Kumar Sarin | 2013 | J Gastroenterol Hepatol2013，，8： | 2 |
| 10 | Probiotics Prevent Hepatic Encephalopathy in Patients With Cirrhosis: A Randomized Controlled Trial显示文摘 | Manish Kumar Lunia Barjesh Chander Sharma Praveen Sharma Sanjeev Sachdeva Siddharth Srivastava | 2014 | Clinical Gastroenterology and Hepatology2014，，： | 2 |
| 11 | Probiotics Prevent Hepatic Encephalopathy in Patients With Cirrhosis: A Randomized Controlled Trial显示文摘 | Manish Kumar Lunia Barjesh Chander Sharma Praveen Sharma Sanjeev Sachdeva Siddharth Srivastava | 2014 | Clinical Gastroenterology and Hepatology2014，，： | 1 |
| 12 | An open label randomised controlled trial of probiotics for primary prophylaxis of hepatic encephalopathy in patients with cirrhosis显示文摘 | Manish Kumar Lunia Barjesh Chander Sharma Sanjeev Sachdeva Siddharth Srivastava | 2013 | Journal of Clinical and Experimental Hepatology2013，，1： | 1 |
| 13 | A randomized controlled trial comparing lactulose, probiotics, and L-ornithine L-aspartate in treatment of minimal hepatic encephalopathy显示文摘 | Vibhu Vibhas Mittal Barjesh Chander Sharma Praveen Sharma Shiv Kumar Sarin | 2011 | European Journal of Gastroenterology & Hepatology2011，，8： | 1 |
| 14 | A randomized controlled trial comparing lactulose, probiotics, and L-ornithine L-aspartate in treatment of minimal hepatic encephalopathy显示文摘 | Vibhu Vibhas Mittal Barjesh Chander Sharma Praveen Sharma Shiv Kumar Sarin | 2011 | European Journal of Gastroenterology & Hepatology2011，，8： | 1 |
| 15 | Biliary microlithiasis in patients with idiopathic acute pancreatitis and unexplained biliary pain: Response to therapy显示文摘 | VIVEK ASARASWAT BARJESH CSHARMA DEEPAK KAGARWAL RAKESHKUMAR TAJESHWAR SNEGI RAKESH KTANDON | 2004 | Journal of Gastroenterology and Hepatology2004，，10： | 1 |
| 16 | Primary prophylaxis of gastric variceal bleeding comparing cyanoacrylate injection and beta-blockers: A randomized controlled trial显示文摘 | Smruti Ranjan Mishra Barjesh Chander Sharma Ashish Kumar Shiv Kumar Sarin | 2010 | Journal of Hepatology2010，，6： | 1 |
| 17 | Infliximab monotherapy for severe alcoholic hepatitis and predictors of survival: An open label trial显示文摘 | Praveen Sharma Ashish Kumar Barjesh Chander Sharma Shiv Kumar Sarin | 2009 | Journal of Hepatology2009，，3： | 1 |
| 18 | Minimal hepatic encephalopathy: Consensus statement of a working party of the Indian National Association for Study of the Liver显示文摘 | Radha KDhiman Vivek ASaraswat Barjesh KSharma Shiv KSarin Yogesh KChawla RogerButterworth AjayDuseja RakeshAggarwal DeepakAmarapurkar PraveenSharma KaushalMadan SamirShah Avnish KSeth Rakesh KGupta AbrahamKoshy Ramesh RRai Jang B.Dilawari Sri PrakashMishr | 2010 | Journal of Gastroenterology and Hepatology2010，，6： | 1 |
| 19 | Addition of Propranolol and Isosorbide Mononitrate to Endoscopic Variceal Ligation Does Not Reduce Variceal Rebleeding Incidence显示文摘 | Ashish Kumar Sanjeev Kumar Jha Praveen Sharma Saroj Dubey Pankaj Tyagi Barjesh Chander Sharma Shiv Kumar Sarin | 2009 | Gastroenterology2009，，3： | 1 |
| 20 | Endoscopic biliary drainage for severe acute cholangitis in biliary obstruction as a result of malignant and benign diseases显示文摘 | RAKESHKUMAR BARJESH CSHARMA JAGDEEPSINGH SHIV KSARIN | 2004 | Journal of Gastroenterology and Hepatology2004，，9： | 1 |
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