Qualification: 
MD, DM, MBBS
anoopkkoshy@aims.amrita.edu

Dr. Anoop Koshy currently serves as Professor at the Department of Gastroenterology, School of Medicine, Kochi. He pursued his MD in Medicine and DM in Gastroenterology. 

Publications

Publication Type: Journal Article

Year of Publication Title

2019

Anoop K Koshy, Harshavardhan, R. B., Siyad, I., and Venu, R. P., “Impact of Calcifications on Diagnostic Yield of Endoscopic Ultrasound-Guided Fine-Needle Aspiration for Pancreatic Ductal Adenocarcinoma”, Indian J Gastroenterol, 2019.[Abstract]


INTRODUCTION: Chronic calcific pancreatitis (CCP) is a major risk factor for pancreatic ductal adenocarcinoma (PDAC) and is common in southern India. Endoscopic ultrasound fine-needle aspiration (EUS-FNA) is useful for tissue acquisition in patients with solid pancreatic lesions. Multiple factors may affect the diagnostic yield of FNA samples. The present study was performed to assess the impact of pancreatic calcifications on the diagnostic yield of EUS-FNA in PDAC.

METHODS: All patients with confirmed PDAC from January 2013 to December 2017 were included. CCP was diagnosed based on typical imaging characteristics with or without evidence of pancreatic insufficiency along with surgical histopathology reports showing features of chronic pancreatitis. The diagnostic yield and adequacy of cellularity were  assessed by a pathologist who was blinded and were compared between the two groups: group 1: PDAC patients with no evidence of CCP and, group 2: PDAC patients with CCP.

RESULTS: A total of 122 patients were included in the study. The diagnostic yield was lower in patients in group 2 (n = 42, 25 [59.52%]) as compared to those in group 1 (n = 80, 63 [78.75%]) (p-value = 0.01). On multivariate analysis, only the presence of calcifications was found to have an independent association with diagnostic yield (odds ratio 3.83 [95% confidence interval 1.22-11.9]).

CONCLUSIONS: CCP had a significant impact on the diagnostic yield of EUS-FNA for pancreatic adenocarcinoma. Novel techniques and newer technology that may mitigate the negative effect of calcification on diagnostic yield of EUS-FNA in patients with CCP.

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2018

A. Prakash, Anoop K Koshy, B, H. Rao, and Venu, R. P., “Endoscopic Ultrasound-Guided Rendezvous Procedure for a Nondilated, Leaking Pancreatic Duct”, ACG Case Rep J, vol. 5, p. e105, 2018.[Abstract]


Pancreatic duct (PD) leak leading to pancreatic ascites is a serious complication of chronic pancreatitis. Endoscopic management with endoscopic retrograde cholangiopancreatography (ERCP) has been found to be successful; however, if selective cannulation of the PD is unsuccessful, an endoscopic ultrasound-guided rendezvous procedure can help in bridging PD leaks, provided the duct is dilated. We report a successful endoscopic ultrasound-guided rendezvous procedure in a patient with PD leak, pancreatic ascites, and a nondilated duct with failed ERCP who was a poor candidate for surgery. The pancreatic ascites resolved following the procedure.

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