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| 1 | Islet cell dysfunction in patients with chronic pancreatitis显示文摘Chronic pancreatitis(CP)is characterized by progressive inflammation and fibrosis of the pancreas that eventually leads to pancreatic exocrine and endocrine insufficiency.Diabetes in the background of CP is very difficult to manage due to high glycemic variability and concomitant malabsorption.Progressive beta cell loss leading to insulin deficiency is the cardinal mechanism underlying diabetes development in CP.Alpha cell dysfunction leading to deranged glucagon secretion has been described in different studies using a variety of stimuli in CP.However,the emerging evidence is varied probably because of dependence on the study procedure,the study population as well as on the stage of the disease.The mechanism behind islet cell dysfunction in CP is multifactorial.The intra-islet alpha and beta cell regulation of each other is often lost.Moreover,secretion of the incretin hormones such as glucagon like peptide-1 and glucose-dependent insulinotropic polypeptide is dysregulated.This significantly contributes to islet cell disturbances.Persistent and progressive inflammation with changes in the function of other cells such as islet delta cells and pancreatic polypeptide cells are also implicated in CP.In addition,the different surgical procedures performed in patients with CP and antihyperglycemic drugs used to treat diabetes associated with CP also affect islet cell function.Hence,different factors such as chronic inflammation,dysregulated incretin axis,surgical interventions and anti-diabetic drugs all affect islet cell function in patients with CP.Newer therapies targeting alpha cell function and beta cell regeneration would be useful in the management of pancreatic diabetes in the near future. | Ayan Roy Jayaprakash Sahoo Sadishkumar Kamalanathan Dukhabandhu Naik Pazhanivel Mohan Biju Pottakkat | 2020 | World Journal of Diabetes2020，11，7： | 5 |
| 2 | Pathological abnormalities in splenic vasculature in non-cirrhotic portal hypertension:Its relevance in the management of portal hypertension显示文摘BACKGROUND Portal hypertension(PH)is associated with changes in vascular structure and function of the portosplenomesenteric system(PSMS).This is referred to as portal hypertensive vasculopathy.Pathological abnormalities of PSMS has been described in the literature for cirrhotic patients.Raised portal pressure and hyperdynamic circulation are thought to be the underlying cause of this vasculopathy.In view of this,it is expected that pathological changes in splenic and portal vein similar to those reported in cirrhotic patients with PH may also be present in patients with non-cirrhotic PH(NCPH).AIM To investigate pathological abnormalities of splenic vein in patients with NCPH,and suggest its possible implications in the management of PH.METHODS A prospective observational study was performed on 116 patients with NCPH[Extrahepatic portal vein obstruction(EHPVO):53 and non-cirrhotic portal fibrosis(NCPF):63]who underwent proximal splenorenal shunt(PSRS),interposition shunt or splenectomy with devascularization in JIPMER,Pondicherry,India,a tertiary level referral center,between 2011-2016.All patients were evaluated by Doppler study of PSMS,computed tomography portovenogram and upper gastrointestinal endoscopy.An acoustic resonance forced impulse(ARFI)scan and abdomen ultrasound were done for all cases to exclude cirrhosis.Intraoperative and histopathological assessment of the harvested splenic vein was performed in all.The study group was divided into delayed and early presentation based on the median duration of symptoms(i.e.108 mo).RESULTS The study group comprising of 116 patients[77(66%)females and 39(34%)males]with NCPH had a median age of 22 years.Median duration of symptoms was 108 mo.The most common presentation in both EHPVO and NCPF patients was upper gastrointestinal bleeding(hematemesis and melena).The ARFI scan revealed a median score of 1.2(1.0-1.8)m/s for EHPVO and 1.5(0.9-2.8)m/s for NCPF.PSRS was performed in 84 patients(two of whom underwent interposition PSRS using a 10 mm Dacron graft);splenoadrenal shunt in 9;interposition mesocaval shunt in 5;interposition 1st jejunal to caval shunt in 1 patient and devascularization with splenectomy in 17 patients.Median presplenectomy portal pressure was 25(range:15-51)mm Hg.In 77%cases,the splenic vein was abnormal upon intraoperative assessment.Under macroscopic examination,wall thickening was observed in 108(93%),venous thrombosis in 32(28%)and vein wall calcification in 27(23%)cases.Upon examination under a surgical magnification loupe,21(18%)patients had intimal defects in the splenic vein.Histopathological examination of veins was abnormal in all cases.Medial hypertrophy was noted in nearly all patients(107/116),while intimal fibrosis was seen in 30%.Ninety one percent of patients with intimal fibrosis also had venous thrombosis.Vein wall calcification was found in 22%,all of whom had intimal fibrosis and venous thrombosis.The proportion of patients with pathological abnormalities in the splenic vein were significantly greater in the delayed presentation group as compared to the early presentation group.CONCLUSION Pathological changes in the splenic vein similar to those in cirrhotic patients with PH are noted in NCPH.We recommend that PH in NCPH be treated as systemic and pulmonary hypertension equivalent in the gastrointestinal tract,and that early aggressive therapy be initiated to reduce portal pressure and hemodynamic stress to avoid potential lethal effects. | Shahana Gupta Biju Pottakkat Surendra Kumar Verma Raja Kalayarasan Sandip Chandrasekar A Ajith Ananthakrishna Pillai | 2020 | World Journal of Gastrointestinal Surgery2020，12，1： | 3 |
| 3 | Gastroenteropancreatic neuroendocrine neoplasms:A clinical snapshot显示文摘Our understanding about the epidemiological aspects,pathogenesis,molecular diagnosis,and targeted therapies of neuroendocrine neoplasms(NENs)have drastically advanced in the past decade.Gastroenteropancreatic(GEP)NENs originate from the enteroendocrine cells of the embryonic gut which share common endocrine and neural differentiation factors.Most NENs are welldifferentiated,and slow growing.Specific neuroendocrine biomarkers that are used in the diagnosis of functional NENs include insulin,glucagon,vasoactive intestinal polypeptide,gastrin,somatostatin,adrenocorticotropin,growth hormone releasing hormone,parathyroid hormone-related peptide,serotonin,histamine,and 5-hydroxy indole acetic acid(5-HIAA).Biomarkers such as pancreatic polypeptide,human chorionic gonadotrophin subunits,neurotensin,ghrelin,and calcitonin are used in the diagnosis of non-functional NENs.5-HIAA levels correlate with tumour burden,prognosis and development of carcinoid heart disease and mesenteric fibrosis,however several diseases,medications and edible products can falsely elevate the 5-HIAA levels.Organ-specific transcription factors are useful in the differential diagnosis of metastasis from an unknown primary of well-differentiated NENs.Emerging novel biomarkers include circulating tumour cells,circulating tumour DNA,circulating micro-RNAs,and neuroendocrine neoplasms test(NETest)(simultaneous measurement of 51 neuroendocrine-specific marker genes in the peripheral blood).NETest has high sensitivity(85%-98%)and specificity(93%-97%)for the detection of gastrointestinal NENs,and is useful for monitoring treatment response,recurrence,and prognosis.In terms of management,surgery,radiofrequency ablation,symptom control with medications,chemotherapy and molecular targeted therapies are all considered as options.Surgery is the mainstay of treatment,but depends on factors including age of the individual,location,stage,grade,functional status,and the heredity of the tumour(sporadic vs inherited).Medical management is helpful to alleviate the symptoms,manage inoperable lesions,suppress postoperative tumour growth,and manage recurrences.Several molecular-targeted therapies are considered second line to somatostatin analogues.This review is a clinical update on the pathophysiological aspects,diagnostic algorithm,and management of GEP NENs. | Cornelius J Fernandez Mayuri Agarwal Biju Pottakkat Nisha Nigil Haroon Annu Susan George Joseph MPappachan | 2021 | World Journal of Gastrointestinal Surgery2021，13，3： | 1 |
| 4 | Reoperation following Pancreaticoduodenectomy显示文摘 | J. R. Reddy R. Saxena R. K. Singh B. Pottakkat A. Prakash A. Behari A. K. Gupta V. K. Kapoor Michael Hünerbein | 2012 | International Journal of Surgical Oncology2012，，： | 1 |
| 5 | Primary hyperparathyroidism presenting as acute pancreatitis: An institutional experience with review of the literature显示文摘BACKGROUND Acute pancreatitis(AP)presenting as an initial manifestation of primary hyperparathyroidism(PHPT)is uncommon,and its timely diagnosis is crucial in preventing recurrent attacks of pancreatitis.AIM To determine the clinical,biochemical,and radiological profile of PHPT patients presenting as AP.METHODS This is a retrospective observational study,51 consecutive patients admitted with the diagnosis of PHPT during January 2010 and October 2021 at a tertiary care hospital in Puducherry,India was included.The diagnosis of AP was established in the presence of at least two of the three following features:abdominal pain,levels of serum amylase or lipase greater than three times the normal,and characteristic features at abdominal imaging.RESULTS Out of the 51 consecutive patients with PHPT,twelve(23.52%)had pancreatitis[5(9.80%)AP,seven(13.72%)chronic pancreatitis(CP)].PHPT with AP(PHPT-AP)was more common among males with the presentation at a younger age(35.20±16.11 vs 49.23±14.80 years,P=0.05)and lower plasma intact parathyroid hormone(iPTH)levels[125(80.55-178.65)vs 519.80(149-1649.55,P=0.01)]compared to PHPT without pancreatitis(PHPT-NP).The mean serum calcium levels were similar in both PHPT-AP and PHPT-NP groups[(11.66±1.15 mg/dL)vs(12.46±1.71 mg/dL),P=0.32].PHPT-AP also presented with more gastrointestinal symptoms like abdominal pain,nausea,and vomiting with lesser skeletal and renal manifestations as compared to patients with PHPT-NP.CONCLUSION AP can be the only presenting feature of PHPT.Normal or higher serum calcium levels during AP should always draw attention towards endocrine causes like PHPT. | K G Rashmi Sadishkumar Kamalanathan Jayaprakash Sahoo Dukhabandhu Naik Pazhanivel Mohan Biju Pottakkat Sitanshu Sekhar Kar Rajan Palui Ayan Roy | 2022 | World Journal of Gastrointestinal Pharmacology and Therapeutics2022，13，4： | 1 |
| 6 | Recurrent bile duct stricture:causes and long-term results of surgical management显示文摘 | Pottakkat B Sikora SS Kumar A | 2007 | J Hepatobil Pancreat Surg2007，14，2： | 1 |
| 7 | Recurrent bile duct stricture: causes and long - term results of surgical management 显示文摘 | Pottakkat B Sikora SS Kumar A | 2007 | J Hepatobil Pancreat Surg2007，14，2： | 1 |
| 8 | Recurrent bile duct stricture : causes and long-term results of surgical management 显示文摘 | Biju Pottakkat Sadiq S Sikora | 2007 | J nepatobiliary Pancreat Surg2007，14，2： | 1 |
| 9 | Biliary ascariasis : mimicker of re- tained bile duct stone显示文摘 | Goel A Lakshmi CP Pottakkat B | 2012 | Dig Endosc2012，24，6： | 1 |
| 10 | Recurrent bile duct stricture: causes and long - term results of surgical management 显示文摘 | Pottakkat B Sikora SS Kumar A | 2007 | J Hepatobil Pancreat Surg2007，14，2： | 1 |
| 11 | Modified binding pancreaticogastrostomy vs modified Blumgart pancreaticojejunostomy after laparoscopic pancreaticoduodenectomy for pancreatic or periampullary tumors显示文摘BACKGROUND Laparoscopic pancreaticoenteric anastomosis is one of the technically challenging steps of minimally invasive pancreaticoduodenectomy(PD),especially during the learning curve.Despite multiple randomized controlled trials and meta-analyses,the type of pancreatico-enteric anastomosis as a risk factor for post-pancreatectomy complications is debatable.Also,the ideal technique of pancreatic reconstruction during the learning curve of laparoscopic PD has not been well studied.AIM To compare the short-term outcomes of modified binding pancreaticogastrostomy(PG)and Blumgart pancreaticojejunostomy(PJ)during learning curve of laparoscopic PD.METHODS The first 25 patients with resectable pancreatic or periampullary tumors who underwent laparoscopic PD with modified binding PG or modified Blumgart PJ between January 2015 and May 2020 were retrospectively analyzed to compare perioperative outcomes during the same learning curve.A single layer of the fullthickness purse-string suture was placed around the posterior gastrotomy in the modified binding PG.In the modified Blumgart technique,only a single transpancreatic horizontal mattress suture was placed on either side of the pancreatic duct(total two sutures)to secure the pancreatic parenchyma to the jejunum.Also,on the ventral surface,the knot is tied on the jejunal wall without going through the pancreatic parenchyma.Post pancreatectomy complications are graded as per the RESULTS During the study period,modified binding PG was performed in 27 patients and modified Blumgart PJ in 29 patients.The demographic and clinical parameters of the first 25 patients included in both groups were comparable.Lower end cholangiocarcinoma and ampullary adenocarcinoma were the primary indications for laparoscopic PD in both groups(32/50,64%).The median operative time for pancreatic reconstruction was significantly lower in the binding PG group(42 vs 58 min,P=0.01).The clinically relevant(Grade B/C)postoperative pancreatic fistula(POPF)was significantly more in the modified PJ group(28%vs 4%,P=0.04).In contrast,intraluminal postpancreatectomy hemorrhage(PPH)was more in the binding PG group(32%vs 4%,P=0.02).There was no significant difference in the incidence of delayed gastric emptying between the two groups.CONCLUSION During the learning curve of laparoscopic PD,modified binding PG reduces POPF but is associated with increased intraluminal PPH compared to PJ using the modified Blumgart technique. | Satyaprakash Ray Choudhury Raja Kalayarasan Senthil Gnanasekaran Biju Pottakkat | 2022 | World Journal of Clinical Oncology2022，13，5： | 1 |
| 12 | Postcholecystectomy benign biliary strictures-long-term results 显示文摘 | Sikora SS Pottakkat B Srikanth G | 2006 | Dig Surg2006，23，56： | 1 |
| 13 | Postcholecystectomy be- nign biliary strictures-long-term results 显示文摘 | Sikora SS Pottakkat B Srikanth G | 2006 | Dig Surg2006，23，56： | 1 |
| 14 | Recurrent bile duct stricture : causes and long-term results of surgical management显示文摘 | Pottakkat B Sikora SS Kumar A | 2007 | J Hepatobil Pancreat Surg2007，14，2： | 1 |
| 15 | Tuberculosis of the spleen as a cause of fever of unknown origin and splenomegaly显示文摘 | Pottakkat B Kumar A Rastogi A | 2010 | Gut Liver2010，4，1： | 1 |
| 16 | Recurrent bile duct stricture: causes and long-term results of surgical management显示文摘 | Biju Pottakkat Sadiq S. Sikora Ashok Kumar Rajan Saxena Vinay K. Kapoor | 2007 | Journal of Hepato - Biliary - Pancreatic Surgery2007，，2： | 1 |
| 17 | Tuberculosis of the spleen as a cause of fever of unknown origin and splenomegaly显示文摘 | Pottakkat B Kumar A Rastogi A | 2010 | Gut and liver2010，4，1： | 1 |
| 18 | Recurrent bile duct stric- ture: causes and long-term results of surgical management 显示文摘 | Pottakkat B Sikora SS Kumar A | 2007 | J Hepatobiliary Pancreat Surg2007，14，2： | 1 |
| 19 | Factorspredicting failure following high bilio - enteric anastomosis forpost - cholecystectomy benign biliary strictures 显示文摘 | POTTAKKAT B VIJAYAHARI R PRAKASH A | 2010 | J Gas-trointes Sury2010，14，9： | 1 |
| 20 | Appraisal of gastric stump carcinoma and current state of affairs显示文摘Gastric stump carcinoma,also known as remnant gastric carcinoma,is a malignancy arising in the remnant stomach following gastrectomy for a benign or malignant condition.Enterogastric reflux and preexisting risk factors in a patient with gastric cancer are the major contributors to the development of gastric stump carcinoma.The occurrence of gastric stump carcinoma is time-dependent and seen earlier in patients operated on for malignant rather than benign diseases.The tumor location is predominantly at the anastomotic site towards the stomach.However,it can occur anywhere in the remnant stomach.The pattern of lymph node involvement and the type of surgery required is distinctly different compared to primary gastric cancer.Gastric stump carcinoma is traditionally considered a malignancy with a dismal outcome.However,recent advances in diagnostic and therapeutic strategies have improved outcomes.Recent advances in molecular profiling of gastric stump carcinoma have identified distinct molecular subtypes,thereby providing novel therapeutic targets.Also,reports of gastric stump carcinoma following pancreatoduodenectomy and bariatric surgery highlight the need for more research to standardize the diagnosis,staging,and treatment of these tumors.The present review aims to provide an overview of gastric stump carcinoma highlighting the differences in clinicopathological profile and management compared to primary gastric carcinoma. | Ankit Shukla Raja Kalayarasan Senthil Gnanasekaran Biju Pottakkat | 2023 | World Journal of Clinical Cases2023，11，13： | 0 |
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