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| 1 | Evaluating the accuracy of American Society for Gastrointestinal Endoscopy guidelines in patients with acute gallstone pancreatitis with choledocholithiasis显示文摘BACKGROUND Acute gallstone pancreatitis(AGP) is the most common cause of acute pancreatitis(AP) in the United States. Patients with AGP may also present with choledocholithiasis. In 2010, the American Society for Gastrointestinal Endoscopy(ASGE) suggested a management algorithm based on probability for choledocholithiasis, recommending additional imaging for patients at intermediate risk and endoscopic retrograde cholangiopancreatography(ERCP) for patients at high risk of choledocholithiasis. In 2019, the ASGE guidelines were updated using more specific criteria to categorize individuals at high risk for choledocholithiasis. Neither ASGE guideline has been studied in AGP to determine the probability of having choledocholithiasis.AIM To determine compliance with ASGE guidelines, assess outcomes, and compare 2019 vs 2010 ASGE criteria for suspected choledocholithiasis in AGP.METHODS We conducted a retrospective cohort study of 882 patients admitted with AP to a single tertiary care center from 2008-2018. AP was diagnosed using revised Atlanta criteria and AGP was defined as the presence of gallstones on imaging or with cholestatic pattern of liver injury in the absence of another cause. Patients with chronic pancreatitis and pancreatic malignancy were excluded as were those who went directly to cholecystectomy prior to assessment for choledocholithiasis. Patients were assigned low, intermediate or high risk based on ASGE guidelines. Our primary outcomes of interest were the proportion of patients in the intermediate risk group undergoing magnetic resonance cholangiopancreatography(MRCP) first and the proportion of patients in the high risk group undergoing ERCP directly without preceding imaging. Secondary outcomes of interest included outcome differences based on if guidelines were not adhered to. We then evaluated the diagnostic accuracy of 2019 in comparison to the 2010 ASGE criteria for patients with suspected choledocholithiasis. We performed the t test or Wilcoxon rank sum test, as appropriate, to analyze if there were outcome differences based on if guidelines were not adhered to. Kappa coefficients were calculated to measure the degree of agreement between pairs of variables.RESULTS In this cohort, we identified 235 patients with AGP of which 79 patients were excluded as they went directly to surgery for cholecystectomy without prior MRCP or ERCP. Of the remaining 156 patients, 79 patients were categorized as intermediate risk and 77 patients were high risk for choledocholithiasis according to the 2010 ASGE guidelines. Among 79 intermediate risk patients, 54(68%) underwent MRCP first whereas 25 patients(32%) went directly to ERCP. For the 54 patients with intermediate risk who had MRCP first, 36 patients had no choledocholithiasis while 18 patients had evidence of choledocholithiasis prompting ERCP. Of these patients, ERCP confirmed stone disease in 11 patients. Of the 25 intermediate risk patients who directly underwent ERCP, 18 patients had stone disease. One patient with a normal ERCP developed post ERCP pancreatitis. Patients undergoing MRCP in this group had a significantly longer length of stay(5.0 vs 4.0 d, P = 0.02). In the high risk group, 64 patients(83%) had ERCP without preceding imaging, of which, 53 patients had findings consistent with choledocholithiasis, of which 13 patients(17%) underwent MRCP before ERCP, all of which showed evidence of stone disease. Furthermore, all of these patients ultimately had an ERCP, of which 8 patients had evidence of stones and 5 had normal examination.RESULTS Our cohort also demonstrated that 58% of all 156 patients with AGP had confirmed choledocholithiasis(79% of the high risk group and 37% of the intermediate group when risk was assigned based on the 2010 ASGE guidelines). When the updated 2019 ASGE guidelines were applied instead of the original 2010 guidelines, there was moderate agreement between the 2010 and 2019 guidelines(kappa = 0.46, 95%CI: 0.34-0.58). Forty-two of 77 patients were still deemed to be high risk and 35 patients were downgraded to intermediate risk. Thirty-five patients who were originally assigned high risk were reclassified as intermediate risk. For these 35 patients, 26 patients had ERCP findings consistent with choledocholithiasis and 9 patients had a normal examination. Based on the 2019 criteria, 9/35 patients who were downgraded to intermediate risk had an unnecessary ERCP with normal findings(without a preceding MRCP).CONCLUSION Two-thirds in intermediate risk and 83% in high risk group followed ASGE guidelines for choledocholithiasis. One intermediate-group patient with normal ERCP had post-ERCP AP, highlighting the risk of unnecessary procedures. | Supisara Tintara Ishani Shah William Yakah Awais Ahmed Cristina S Sorrento Cinthana Kandasamy Steven D Freedman Darshan J Kothari Sunil G Sheth | 2022 | World Journal of Gastroenterology2022，28，16： | 3 |
| 2 | Do institutional investors exacerbate managerial myopia?显示文摘 | Sunil Wahal John J McConnell | 2000 | Journal of Corporate Finance2000，，3： | 2 |
| 3 | Protective effect of Sida cordata leaf extract against CCl_4 induced acute liver toxicity in rats显示文摘Objective:To investigate the hepatoprotective potential of Sida cordata(Malvaceae)(S.cordata) in experimental rats to validate its traditional claim.Methods:Wister albino rats were divided into 6 groups:Croup 1 served as control;CroupⅡserved as hepatotoxic(CCl4 treated) group; CroupⅢ,Ⅳand V served as(100,200 and 400 mg/kg b.w.) S.cordata leaf extract(SCLE) treated groups;CroupⅥserved as positive control(Silymarin) treated group.Liver marker enzymes serum glutamate oxyloacetic transaminase,serum glutamic pyruvic transaminase,pancreatic enzymatic antioxidants superoxide dismutase(SOD),lipid peroxidation,catalase(CAT),reduced glutathione(CSH) were measured and compared along with histopathological studies.Results: Obtained results show that the treatment with SCI.E significantly(P<0.05-<0.001) and dosedependently reduced CCl4 induced elevated serum level of hepatic enzymes.Furthermore, SCLE significantly(up to P<0.001) reduced the lipid peroxidation in the liver tissue and restored activities of defence antioxidant enzymes CSH,SOD and CAT towards normal levels,which was confirmed by the histopathological studies.Conclusions:The results of this study strongly indicate the protective effect of SCLE against CCl4 induced acute liver toxicity in rats and thereby scientifically support its traditional use. | Sunil Mistry KR Dutt J Jena | 2013 | Asian Pacific Journal of Tropical Medicine2013，6，4： | 2 |
| 4 | Extracellular polymeric substances and structural stability of aerobic granule 显示文摘 | Sunil A Lee D Tay J | | Water Res0，42，67： | 1 |
| 5 | Improving truck underhood thermal management through CFD显示文摘 | Timothy P N Sunil K J | 2002 | SAE Technical Paper Series2002，，： | 1 |
| 6 | Functional and inflammatoryalterations in the lung following exposure of rats to nitrogen mustard显示文摘 | Sunil VR Patel KJ Shen J | 2011 | Toxicol Appl Pharmacol2011，250，1： | 1 |
| 7 | Decreasing the apoptotic threshold of tumor cells through protein kinase C inhibition and shingomyelinase activation increases tumor killing by ionizing radiation 显示文摘 | Steven J HeJena J Sunil A | 1997 | Cancer Res1997，57，： | 1 |
| 8 | Sorption of Nz,O2,and Ar in Mn ( lI )-Exchanged Zeolite A and X Using Volumetric Mea- surements and Grand Canonical Monte Carlo Simulation显示文摘 | SEBASTIAN J PILLAI R S SUNIL A | 2007 | Ind Eng Chem Res2007，46，3： | 1 |
| 9 | Connective tissue growth factor: Potential role in glomerulosclerosis and tubulointerstitial fibrosis显示文摘 | Sunil Gupta Michael R Clarkson J D | 2000 | Kid Int2000，58，： | 1 |
| 10 | Chemical and strontium, oxygen, and carbon isotopic compositions of carbonates from the Lesser Himalaya: Implications to the strontium isotope composition of the source waters of the Ganga, Gh- aghara, and the Indus rivers显示文摘 | Sunil K S Trivedi J R Pande K | 1998 | Geochimica et Cosmochimica Acta1998，62，5： | 1 |
| 11 | Prognostic value of cystain Cin acute heart failure in relation to othemiarkers of renal function andNT2 pro BNP显示文摘 | Lassus J Harjola VP Sunil R | 2007 | Eur Heart J2007，28，15： | 1 |
| 12 | Perceived social stress, pregnancy - related anxiety, depression and subjective social status among pregnant Mex- ican and Mexican American women in South Texas 显示文摘 | Fleuriet K J Sunil T S | 2014 | J Health Care Poor Underserved2014，25，2： | 1 |
| 13 | Extraction of extracellular polymeric substances from aerobic granule with compact interior structure 显示文摘 | SUNIL S LEE D J | 2008 | Journal of Hazardous Materials2008，154，： | 1 |
| 14 | Decreasing the apoptotic threshold of tumor cells through protein kinase C inhibition and sphingomyelinase activation increases tumor killing by ionizing radiation 显示文摘 | Steven J Helena J Sunil A | 1997 | Cancer Res1997，57，19： | 1 |
| 15 | CCSweep:antomatic decomposition of multi-sweep volumes显示文摘 | David R White Sunil Saigal Steven J Owen | 2004 | Engineering with Computers2004，20，3： | 1 |
| 16 | Extraction of extracellular polymeric substances from aerobic granule with compact interior structure显示文摘 | Sunil S Lee D J | | 0，，15： | 1 |
| 17 | Mapping invasive tamarix: a comparison of single-scene and time series analyses of remotely sensed data显示文摘 | Thomson J S Jeffrey T M Sunil K | 2009 | Remote Sensing2009，，1： | 1 |
| 18 | Effects of N-doping on the microstructure, mechanical and tribological behavior of Cr-DLC films显示文摘 | Sunil K P JIANG J C Efstathios I | 2007 | Meletis Surf Coat Technol2007，201，： | 1 |
| 19 | Acute endotox- emia is associated With upregulation of lipocalin 24p3/Lcn2 in lung and liver显示文摘 | Sunil VR Patel K J Nilsen - Hamilton M | 2007 | Exp Mol Pathol2007，83，2： | 1 |
| 20 | Primitive neuroectodermal tumor of the sternum in a child:resection and reconstruction显示文摘 | Sunil I Bond S J Nagaraj HS | | 0，，11： | 1 |
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