KIMS Hospital is the largest independent private hospital in Kent. It is situated in Maidstone and treats privately insured, self-funding and NHS patients. It is situated on the Kent Medical Campus, off Junction 7 of the M20 Motorway.
Background OCT improves PCI outcomes compared with angiography alone but requires contrast to displace blood for image acquisition. In patients at risk of contrast-induced nephropathy, minimizing contrast use is clinically important. Objectives The objective of the study was to compare heparinized saline and contrast as flushing media for coronary frequency domain optical coherence tomography (OCT) during percutaneous coronary intervention (PCI). Methods In this prospective, multicenter, observational study, paired contrast and heparinized saline OCT pullbacks were obtained during the same procedure from 166 patients undergoing PCI at 4 tertiary centers in India. A total of 2072 matched pairs of OCT frames (in 259 paired OCT runs) were analyzed by 2 blinded investigators. Vessel dimensions including proximal reference diameter, minimal lumen area, minimum lumen diameter, and distal reference diameter (DRD) were compared. Ethical approval was obtained at all participating institutions, and all patients provided informed consent. Results Saline and contrast-based OCT demonstrated no significant differences in proximal reference diameter (2.76 ± 0.59 vs 2.74 ± 0.60 mm; P = 0.65), minimal lumen area (5.33 ± 2.48 vs 5.36 ± 2.52 mm2; P = 0.85), minimum lumen diameter (2.55 ± 0.68 vs 2.56 ± 0.66 mm; P = 0.78), or distal reference diameter (2.54 ± 0.55 vs 2.55 ± 0.55 mm; P = 0.83). Bland-Altman analysis showed good agreement without proportional bias. Interobserver reliability for vessel measurements was moderate to good with Intraclass Correlation Coefficient ranging from 0.69 to 0.79. Sensitivity analysis for clustering confirmed the robustness without proportional bias. No adverse events were observed with saline flushes. Conclusions Heparinized saline provides vessel measurements comparable to contrast media for frequency domain OCT without safety concerns. Saline flushing is a feasible alternative for OCT-guided PCI, particularly in patients at risk of contrast-induced nephropathy.
Background and Aims Endoscopic ultrasound (EUS)-guided drainage is now the preferred first-line treatment for walled-off pancreatic necrosis (WON). Necrotic tissue can be removed either at the time of initial drainage (immediate necrosectomy) or later, using a step-up approach if patients fail to improve. However, the optimal timing of necrosectomy remains unclear. We performed a systematic review and meta-analysis of randomized controlled trials to compare immediate versus step-up necrosectomy following EUS-guided drainage of WON. Methods We systematically searched PubMed/MEDLINE, Embase, and Cochrane CENTRAL from inception through March 2026 for randomized controlled trials comparing immediate necrosectomy during index drainage with a step-up (on-demand) approach. The primary outcome was reintervention-free clinical success (RFCS), defined as resolution of the collection without the need for additional procedures. Secondary outcomes included overall treatment success, adverse events (disease- and procedure-related), number of necrosectomy sessions, length of hospital stay, and mortality. A random-effects meta-analysis was performed using risk ratios (RRs) or mean differences (MDs) with 95% confidence intervals (CIs). Results Four randomized controlled trials, including 215 patients, were analyzed. Reintervention-free clinical success was significantly lower in the immediate necrosectomy group compared with the step-up approach (RR 0.07, 95% CI 0.02-0.25; I (2) = 0%). Overall treatment success, adverse events, and mortality were similar between the two strategies. However, immediate necrosectomy was associated with a substantially higher procedural burden, reflected by a greater number of necrosectomy sessions. These findings were consistent across sensitivity analyses. Conclusions Performing necrosectomy at the time of initial EUS-guided drainage does not improve clinical outcomes and significantly reduces the likelihood of achieving success without additional interventions. A step-up approach, reserving necrosectomy for selected patients who do not improve after drainage, appears to be the more appropriate strategy. Future research should focus on identifying predictors of necrosectomy requirement to support a more individualized treatment approach.
Background:Acute pancreatitis (AP) is frequently complicated by acute kidney injury (AKI), contributing to increased morbidity and mortality. Thoracic epidural analgesia (TEA) may improve splanchnic perfusion, attenuate inflammation, and reduce renal dysfunction. Methods:In this prospective randomized controlled trial, 88 adults with AP were enrolled; 8 were lost to follow-up. Eighty patients were analyzed and randomized to a TEA group (n = 40) or a control group (n = 40). The TEA group received epidural analgesia in addition to standard care. Renal and metabolic parameters, including urine output, serum urea, creatinine, electrolytes, lactate, bicarbonate, and base excess, were monitored. AKI was defined and staged using KDIGO criteria. Statistical analysis was performed using independent t-tests and Chi-square tests, with P < 0.05 considered significant. Results:Baseline characteristics were comparable between groups. Transient hypotension occurred in nine TEA patients and was managed conservatively; no major complications were observed. Postintervention urine output was significantly higher (P = 0.034) and serum urea significantly lower (P = 0.016) in the TEA group. Lactate levels were lower (P = 0.011), bicarbonate levels higher (P = 0.026), and base excess less negative (P = 0.033), indicating improved perfusion and metabolic status. AKI occurred in 7/40 patients in the TEA group and 12/40 in controls, a nonsignificant difference (P = 0.14). However, AKI severity was lower in the TEA group. Conclusion:TEA was associated with improved renal and metabolic parameters and a trend toward reduced AKI incidence and severity in AP, without major adverse effects. Larger multicenter studies are needed for confirmation.
