The etiology of pain in chronic pancreatitis is multi-factorial and includes altered central pain processing. Pancreatic Quantitative Sensory Testing (P-QST) indirectly assesses pain sensitization, yet its clinical significance in relation to psychological comorbidities and quality of life (QoL) remains unclear in Indian populations. The primary objective was to apply an unbiased, data-driven clustering approach using P-QST parameters to stratify patients into centrally sensitized and non-sensitized phenotypes and evaluate their associations with demographic, clinical and patient-reported outcome variables. This cross-sectional study enrolled Indian patients with painful chronic pancreatitis between June 2021 and October 2023. We assessed static (pressure pain thresholds and cold pressor endurance) and dynamic (temporal summation and conditioned pain modulation) P-QST parameters to characterize pain processing. Psychological comorbidities, pain catastrophizing and quality of life were measured using validated questionnaires. We compared demographic, clinical and patient-reported outcome variables across pain phenotypes identified from K-median clustering of P-QST parameters. We enrolled 264 patients (mean [SD] age- 35.6 [11.0] years, male [
Open surgical necrosectomy remains an important intervention for selected patients with infected pancreatic necrosis, yet data on post-recovery health-related quality of life (HRQoL) are limited. We aimed to describe HRQoL outcomes following open necrosectomy. In this single-center observational study, consecutive patients who underwent open surgical necrosectomy for infected pancreatic necrosis were assessed for HRQoL at a single post-recovery time point using the Short Form 36 (SF-36) questionnaire. Domain and composite scores were analyzed descriptively and compared across age groups, disease severity (revised Atlanta classification), culture positivity, and the presence of bowel communication. Eighty-two patients were included (mean age 34.7 ± 11.5 years; 87.8
BACKGROUND:Inflammatory bowel disease (IBD), including ulcerative colitis (UC) and Crohn's disease (CD), poses significant diagnostic challenges, particularly in South-East Asia, where its prevalence has risen sharply. Although endoscopic biopsies and histopathological evaluations are central to IBD management, inconsistencies in sampling, processing and reporting hinder accurate and reliable diagnosis. METHODS:To address these gaps, the Indian Association of Pathologists and Microbiologists (IAPM), the Indian Society of Gastroenterology (ISG) and the Colitis and Crohn's Foundation, India, (CCFI) collaborated to formulate comprehensive guidelines. Using a structured Delphi process and expert consensus, recommendations were developed to standardize biopsy protocols, histological evaluation and reporting of mucosal biopsies and tackling critical diagnostic challenges. RESULTS:The recommendations cover biopsy sampling, optimal processing, orientation, interpretation methods, histopathological algorithms, recommendations on histological scoring, follow-up biopsies and differentiation of IBD from its mimickers based on existing literature and expert's experience. Reporting formats were suggested to ensure uniformity in practice. CONCLUSION:These evidence-based, practical recommendations aim to enhance diagnostic precision, unify practices and improve patient outcomes in IBD care, providing pathologists in resource-diverse settings with a standardized approach to gastrointestinal mucosal biopsy evaluation.
BACKGROUND:Prophylactic complete closure of mucosal defects after resection of gastrointestinal lesions is key to reducing delayed bleeding, but complete closure for large defects can be challenging with conventional through-the-scope clips (TTSC). The introduction of a TTSC with anchor prongs offers ability to approximate margins of larger defects. OBJECTIVE:The study objective was to evaluate prophylactic complete closure after polypectomy, endoscopic mucosal resection (EMR), or endoscopic submucosal dissection (ESD) in large (≥ 20 mm) nonpedunculated colorectal lesions (LNPCLs). METHODS:We conducted a multicenter, single-arm prospective cohort study of the TTSC with anchor prongs for prophylactic closure after EMR/polypectomy or ESD for LNPCLs. Patients were followed for 30 days after the index procedure. The primary outcome was the rate of complete closure of the defect. Other outcomes were the rate of delayed (postprocedural) bleeding, and rate of serious adverse events (SAEs). RESULTS:One hundred five eligible patients were enrolled. Ninety-nine (94.3%) defects had complete closure, with rates of 93.0% (80/86) for EMR/polypectomy and 100.0% (19/19) for ESD procedures. Delayed bleeding occurred in 2 (1.9%) patients by 30 days after the index procedure. Eight (7.6%) patients had ≥ 1 SAE, including bleeding (2 patients), perforation (1), microperforation (1), aspiration (1), nausea (1), and post-polypectomy syndrome (1). CONCLUSION:Prophylactic use of the TTSC with anchor prongs achieved a 94% rate of complete defect closure after EMR/polypectomy or ESD for LNPCLs. The rate of delayed bleeding after closure in this cohort was 1.9%. A prospective RCT is ongoing to further evaluate the clinical outcomes of a TTSC with anchor prongs used for prophylactic closure. TRIAL REGISTRATION:ClinicalTrials.gov number, NCT05653843.
