Dr. Ramakrishna Venugopal currently serves as Consultant at the Department of Gastroenterology, School of Medicine, Kochi.

Qualification : MD, FACP, FACG, AGAF, FASGE


Publication Type: Journal Article

Year of Publication Publication Type Title


Journal Article

H. B. Rao, Ahamed, H., Panicker, S., Sudhindran, S., and Ramakrishna Venugopal, “Endoscopic therapy for biliary strictures complicating living donor liver transplantation: Factors predicting better outcome.”, World J Gastrointest Pathophysiol, vol. 8, no. 2, pp. 77-86, 2017.[Abstract]

AIM: To identify factors predicting outcome of endoscopic therapy in bile duct strictures (BDS) post living donor liver transplantation (LDLT).

METHODS: Patients referred with BDS post LDLT, were retrospectively studied. Patient demographics, symptoms (Pruritus, Jaundice, cholangitis), intra-op variables (cold ischemia time, blood transfusions, number of ducts used, etc.), peri-op complications [hepatic artery thrombosis (HAT), bile leak, infections], stricture morphology (length, donor and recipient duct diameters) and relevant laboratory data both pre- and post-endotherapy were studied. Favourable response to endotherapy was defined as symptomatic relief with > 80% reduction in total bilirubin/serum gamma glutamyl transferase. Statistical analysis was performed using SPSS 20.0.

RESULTS: Forty-one patients were included (age: 8-63 years). All had right lobe LDLT with duct-to-duct anastomosis. Twenty patients (48.7%) had favourable response to endotherapy. Patients with single duct anastomosis, aggressive stent therapy (multiple endoscopic retrograde cholagiography, upsizing of stents, dilatation and longer duration of stents) and an initial favourable response to endotherapy were independent predictors of good outcome (P < 0.05). Older donor age, HAT, multiple ductal anastomosis and persistent bile leak (> 4 wk post LT) were found to be significant predictors of poor response on multivariate analysis (P < 0.05).

CONCLUSION: Endoscopic therapy with aggressive stent therapy especially in patients with single duct-to-duct anastomosis was associated with a better outcome. Multiple ductal anastomosis, older donor age, shorter duration of stent therapy, early bile leak and HAT were predictors of poor outcome with endotherapy in these patients.

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Journal Article

G. Madhu S, Emmanuel James, and Ramakrishna Venugopal, “Appropriateness of antibiotic usage for gastrointestinal disorders in a tertiary care hospital”, European Journal of Hospital Pharmacy, 2016.[Abstract]

Objective To assess antibiotic usage in gastrointestinal disorders with respect to appropriateness, pattern of resistance, and incidence of adverse drug reactions (ADRs).Methodology Antibiotic prescribing in the gastroenterology department of a tertiary care hospital was evaluated using the Gyssens criteria and also by assessing drug related problems (DRPs) using the Pharmaceutical Care Network Europe V.6.2. A total of 173 patients were studied prospectively by a team of clinical pharmacists. Antibiotic susceptibility was prospectively studied; in addition, retrospective data on culture and sensitivity reports of commonly isolated organisms from 1 October 2012 to 30 September 2014 were collected to determine the resistance pattern in previous years. ADRs were evaluated using the Naranjo scale.Results Antibiotic therapy was appropriate in 60% of patients and inappropriate in the remaining patients due to incorrect decision, choice, and use. A total of 184 DRPs and 30 ADRs of antibiotics were identified. In the study patients, the most commonly isolated organism was Escherichia coli (27.3%) followed by Klebsiella pneumoniae (16.7%). Both E coli and K pneumoniae exhibited 100% resistance towards cefotaxime. There was an increase in the resistance of E coli and K pneumoniae against various antibiotics tested in 2013–2014 as compared to the previous year. An empirical antibiotic policy was developed which was endorsed by the gastroenterology department.Conclusions Although antibiotic therapy was appropriate in the majority of patients, irrational use occurred due to incorrect choice, improper dosage, and improper duration of therapy. E coli and K pneumoniae isolates showed an increase in resistance towards various antibiotics tested.

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