Khuroo Mohammad S
Digestive Diseases Centre, Dr. Khuroo's Medical Clinic, Srinagar, India.
Dept. Gastroenterology, Sher-I-Kashmir Institute of Medical Sciences, Srinagar, Kashmir, India.
J Clin Exp Hepatol. 2023 Nov-Dec;13(6):1074-1090. doi: 10.1016/j.jceh.2023.05.010. Epub 2023 May 25.
Endoscopic retrograde cholangiopancreatography (ERCP) has been a significant development in gastrointestinal endoscopy. I did my first ERCP at SKIMS on December 5, 1982, and over the last 40 years, I have performed 10,100 ERCP procedures, including 600 Sphincter of Oddi manometries (SOM), and 3200 therapeutic ERCPs. We were confronted with many clinical challenges that needed answers by applying ERCP as a primary diagnostic tool. These studies gave birth to and/or recognition of several clinical syndromes. The hepatobiliary and pancreatic ascariasis (HBPA) as a clinical disease was recognized in 1985. The nematode, , was the most common cause of hepatobiliary and pancreatic diseases in Kashmir, and its impact on healthcare, clinical profile, management policies, and control measures was identified. Kashmir was recognized as an endemic zone for recurrent pyogenic cholangitis (RPC), which constituted 12.5% of all biliary diseases. RPC in this population was found essentially to be an aftermath of HBPA. A subset of patients with hepatic hydatidosis with rupture into the biliary tract was recognized at ERCP and primarily treated by endotherapy. Cholangiographic abnormalities in children with portal cavernoma evolved into the recognition of portal biliopathy. Extensive studies of the sphincter of Oddi manometry in patients with unexplained biliary and/or pancreatic pain following cholecystectomy identified the entity of the sphincter of Oddi dyskinesia (SOD). In a cross-over trial, Nifedipine, compared with a placebo, showed a significant clinical response in 20 of 28 such patients. ERCP studies done in patients with tropical calcific pancreatitis showed an anomalous union of bile and pancreatic ducts. Forty of the 220 patients with liver transplantation had biliary complications namely biliary leaks, bile duct strictures, SOD, and recurrence of underlying primary biliary cholangitis. Biliary complications caused considerable morbidity and mortality in patients with liver transplantation.
内镜逆行胰胆管造影术（ERCP）是胃肠内镜领域的一项重大进展。1982年12月5日，我在斯利那加医学科学研究所（SKIMS）完成了我的首例ERCP。在过去的40年里，我共进行了10100例ERCP手术，其中包括600例Oddi括约肌测压（SOM）和3200例治疗性ERCP。将ERCP作为主要诊断工具时，我们面临着许多需要解答的临床挑战。这些研究催生了多种临床综合征并/或使其得到了认可。1985年，肝胆胰蛔虫病（HBPA）作为一种临床疾病被认识到。蛔虫是克什米尔地区肝胆胰疾病最常见的病因，其对医疗保健、临床特征、管理政策和控制措施的影响也得以明确。克什米尔被认定为复发性化脓性胆管炎（RPC）的流行区，该病占所有胆道疾病的12.5%。该人群中的RPC本质上被发现是HBPA的后果。在ERCP检查中发现了一部分肝包虫病破裂入胆道的患者，并主要通过内镜治疗。门静脉海绵样变性患儿的胆管造影异常促使人们认识到门静脉性胆管病。对胆囊切除术后出现不明原因胆绞痛和/或胰绞痛患者进行的Oddi括约肌测压广泛研究，明确了Oddi括约肌运动障碍（SOD）这一病症。在一项交叉试验中，硝苯地平与安慰剂相比，在28例此类患者中有20例显示出显著的临床反应。对热带钙化性胰腺炎患者进行的ERCP研究显示胆胰管汇合异常。220例肝移植患者中有40例出现胆道并发症，即胆漏、胆管狭窄、SOD以及潜在原发性胆汁性胆管炎复发。胆道并发症在肝移植患者中导致了相当高的发病率和死亡率。
