Pradeep Kumar Siddappa, MD

All Publications

• Pancreatic Cyst Fluid Analysis. Gastrointestinal endoscopy clinics of North America Siddappa, P. K., Park, W. G. 2023; 33 (3): 599-612

  Abstract

  Pancreatic cyst fluid analysis can help diagnose pancreatic cyst type and the risk of high-grade dysplasia and cancer. Recent evidence from molecular analysis of cyst fluid has revolutionized the field with multiple markers showing promise in accurate diagnosis and prognostication of pancreatic cysts. The availability of multi-analyte panels has great potential for more accurate prediction of cancer.

  View details for DOI 10.1016/j.giec.2023.03.006

  View details for PubMedID 37245938

• Endoscopic pancreatic duct stenting for pain palliation in selected pancreatic cancer patients: a systematic review and meta-analysis. Gastroenterology report Siddappa, P. K., Hawa, F., Prokop, L. J., Murad, M. H., Abu Dayyeh, B. K., Chandrasekhara, V., Topazian, M. D., Bazerbachi, F. 2021; 9 (2): 105-114

  Abstract

  Background: Abdominal pain is a debilitating symptom affecting 80% of pancreatic cancer (PC) patients. Pancreatic duct (PD) decompression has been reported to alleviate this pain, although this practice has not been widely adopted. We aimed to evaluate the role, efficacy, and safety of endoscopic PD decompression for palliation of PC post-prandial obstructive-type pain.Methods: A systematic review until 7 October 2020 was performed. Two independent reviewers selected studies, extracted data, and assessed the methodological quality.Results: We identified 12 publications with a total of 192 patients with PC presenting with abdominal pain, in whom PD decompression was attempted, and was successful in 167 patients (mean age 62.5years, 58.7% males). The use of plastic stents was reported in 159 patients (95.2%). All included studies reported partial or complete improvement in pain levels after PD stenting, with an improvement rate of 93% (95% confidence interval, 79%-100%). The mean duration of pain improvement was 94±16days. Endoscopic retrograde cholangiopancreatography (ERCP)-related adverse events (AEs) were post-sphincterotomy bleeding (1.8%), post-ERCP pancreatitis (0.6%), and hemosuccus pancreaticus (0.6%). AEs were not reported in two patients who underwent endoscopic ultrasound-guided PD decompression. In the 167 patients with technical success, the stent-migration and stent-occlusion rates were 3.6% and 3.0%, respectively. No AE-related mortality was reported. The methodological quality assessment showed the majority of the studies having low or unclear quality.Conclusion: In this exploratory analysis, endoscopic PD drainage may be an effective and safe option in selected patients for the management of obstructive-type PC pain. However, a randomized-controlled trial is needed to delineate the role of this invasive practice.

  View details for DOI 10.1093/gastro/goab001

  View details for PubMedID 34026217

• Endoscopic Ultrasound-Guided Random Omental Fine Needle Aspiration: A Novel Technique for the Diagnosis of Peritoneal Carcinomatosis. Clinical endoscopy Siddappa, P. K., Jain, N., Agarwal, N. K., Jain, M., Lamba, G. S. 2020; 53 (5): 594-599

  Abstract

  Diagnostic abdominal paracentesis has been described in literature to have variable sensitivity of 50%-75% for the detection of peritoneal carcinomatosis (PC). We believe that random needle aspirates from the omentum, even in the absence of obvious deposits by endoscopic ultrasound (EUS), could prove malignancy in patients with PC.Consecutive patients who underwent EUS for diagnosis and staging of cancer and found to have ascites were included after obtaining informed consent. EUS-guided fine needle aspiration (EUS-FNA) from random sites in the omentum was performed through the transgastric route using a linear echoendoscope.Fifty-four patients underwent EUS during October 2015 to April 2017 for detection, staging, or FNA of a suspected malignant lesion. Ascites was seen in 17 patients and 15 patients who fulfilled the criteria were included. The procedure was successful in all patients. Cytology was suggestive of malignancy in 12 (80%) but not suggestive of malignancy in 3 (20%) patients. Three patients who tested negative had hyperbilirubinemia with biliary obstruction. Their ascitic fluid analysis result was also negative.Random FNA of the omentum in patients with malignancy-related ascites is highly effective in the diagnosis of PC and could be employed during EUS evaluation of malignancies.

  View details for DOI 10.5946/ce.2019.175

  View details for PubMedID 33027585

  View details for PubMedCentralID PMC7548158

• Utility of narrow band imaging in predicting histology in celiac disease. Indian journal of gastroenterology : official journal of the Indian Society of Gastroenterology Sinha, S. K., Berry, N., Muktesh, G., Siddappa, P., Basha, J., Prasad, K., Appasani, S., Ashat, M., Vaiphei, K., Singh, K., Kochhar, R. 2020; 39 (4): 370-376

  Abstract

  Narrow band imaging (NBI) with magnification better visualizes the duodenal microsurface and mucosal vascularity. NBI delineates villous atrophy better than conventional white light endoscopy.This study was conducted to evaluate the diagnostic accuracy of narrow band imaging with magnification (NBI-ME) in celiac disease (CD).In this prospective study, consecutive patients of suspected CD and controls were subjected to tissue transglutaminase antibody test and endoscopic evaluation initially with white light followed by NBI-ME, and biopsies were taken from duodenum. Duodenal villous patterns on NBI were interpreted as normal, blunted distorted, and absent. Severity of villous atrophy was reported according to the modified Marsh criteria.One hundred and twenty-two patients (mean age of 27.53 ± 13.37 years and a male to female ratio of 1:1.26) and 40 controls were studied. The sensitivity and specificity of NBI-ME in predicting villous atrophy were found to be 95.54% and 90%, respectively. The specificity and negative predictive value of NBI-ME in predicting villous atrophy amongst controls was 100% and 97.5%, respectively. Abnormal findings (blunted and absent villous patterns) combined with elevated transglutaminase antibody (> 5-fold) were found to have high accuracy in predicting villous atrophy.NBI with magnification has high sensitivity and specificity in predicting villous atrophy in patients with celiac disease.

  View details for DOI 10.1007/s12664-020-01030-1

  View details for PubMedID 32705418

• Vasoactive Intestinal Peptide-Secreting Tumors: A Review. Pancreas Siddappa, P. K., Vege, S. S. 2019; 48 (9): 1119-1125

  Abstract

  Vasoactive intestinal peptide-secreting tumors (VIPomas) are a group of rare neuroendocrine tumors, which cause a typical syndrome of watery diarrhea. Most of these tumors are found in the pancreas and are usually detected at a later stage. Although curative resection is not possible in most of these tumors, both symptom and tumor control can be achieved by a multidimensional approach, to enable a long survival of most patients. There are no clear-cut guidelines for the management of VIPomas because of the rarity of this neoplasm and lack of prospective data. In this review, we discuss the available evidence on the clinical features and management of these rare tumors.

  View details for DOI 10.1097/MPA.0000000000001402

  View details for PubMedID 31609932

• Patterns of alcohol consumption and nutrition intake in patients with alcoholic liver disease and alcoholic pancreatitis in North Indian men. JGH open : an open access journal of gastroenterology and hepatology Singh, K. R., Muktesh, G., Gunjan, D., Kochhar, R., Singh, V., Das, A., Siddappa, P., Singh, K. 2019; 3 (4): 316-321

  Abstract

  Chronic alcoholism and nutrition play an important role in liver and pancreatic diseases. To compare drinking habits and nutritional data in patients with alcoholic liver disease (ALD) and alcoholic pancreatitis (ALP).Clinical, anthropometric, dietary intake, laboratory, and imaging data were recorded in consecutive patients of ALD and ALP.In 150 patients of ALP (n = 76) and ALD (n = 74), the age of starting alcohol consumption (19.03 ± 3.78 vs 18.0 ± 2.59 years) and the mean amount of alcohol consumed per day (165.63 ± 87.99 vs 185.50 ± 113.54 g; P = 0.230) were similar. Patients with ALD consumed alcohol on a daily basis more frequently (90.5 vs 72.3%; P = 0.003) and had a longer duration of alcohol intake (21.6 + 0.2 vs 14.5 + 6.9 years; P < 0.0001) than patients in the ALP group. Binge drinking was more common in patients with ALP compared to patients with ALD (60.5 vs 20.3%); P < 0.0001). Patients with ALP had a lower body mass index (19.9 ± 3.49 vs 22.64 ± 4.88 kg/m2; P = 0.001) and more frequent decrease in mid arm circumference (57.9 vs 44.6%; P = 0.042) and triceps skin fold thickness (67.1 vs 52.7%; P = 0.072) compared to patients with ALD.There was no difference in the age of starting alcohol consumption and mean amount of alcohol consumption per day between the groups. Patients with ALD were more likely to be daily drinkers with a longer duration of alcohol intake. However, binge drinking and malnourishment was more common in the ALP group.

  View details for DOI 10.1002/jgh3.12165

  View details for PubMedID 31406925

  View details for PubMedCentralID PMC6684506

• Gastrointestinal Health and Healthy aging Healthy aging: A Complete Guide to Clinical Management Siddappa , P., Birk , J. Springer Nature. . 2019: 67-79
• Tight near-total corrosive strictures of the proximal esophagus with concomitant involvement of the hypopharynx: Flexible endoscopic management using a novel technique. World journal of gastrointestinal endoscopy Dhaliwal, H. S., Kumar, N., Siddappa, P. K., Singh, R., Sekhon, J. S., Masih, J., Abraham, J., Garg, S. 2018; 10 (11): 367-377

  Abstract

  To investigate the role of a novel minimally invasive endoscopic technique in the management of tight near-total corrosive strictures of the proximal esophagus involving the hypopharynx.Two patients with near-total corrosive strictures of the proximal esophagus involving the hypopharynx were managed with the novel endoscopic technique. The technique involved passing a 0.025-inch flexible guide-wire across the stricture, and stricture dilatation, using 10F coaxial diathermy and balloon dilators, followed by electro-incision of the proximal aspect of the residual eccentric stricture by means of a novel approach using a wire-guided sphincterotome.Both patients were successfully managed on an outpatient department basis with the complete relief of symptoms and resolution of strictures on endoscopy and an esophagogram. No adverse events were seen during or after the procedure. There was no recurrence of symptoms at a follow-up of over a year in both cases. There was a significant improvement in the body mass index of both patients after the procedure.We report a novel flexible endoscopic technique for the management of complex hypopharyngo-esophageal strictures. In experienced hands, the procedure is relatively simple, safe and effective with a durable response.

  View details for DOI 10.4253/wjge.v10.i11.367

  View details for PubMedID 30487947

  View details for PubMedCentralID PMC6247097

• Differences between the outcome of recurrent acute pancreatitis and acute pancreatitis. JGH open : an open access journal of gastroenterology and hepatology Mallick, B., Shrama, D. J., Siddappa, P., Dhaka, N., Malik, S., Sinha, S. K., Yadav, T. D., Gupta, V., Kochhar, R. 2018; 2 (4): 134-138

  Abstract

  Overall, a handful of studies are available on the outcomes of recurrent acute pancreatitis (RAP), in comparison to the first episode of acute pancreatitis (AP). We aimed to provide a more complete and updated picture of RAP and how it is different from the initial episode of AP.Consecutive patients admitted with an episode of AP over 8 years were divided into two groups on the basis of prior episodes: AP and RAP. Primary outcome measures were for surgical necrosectomy and mortality.Of the 724 patients (age 39.22 ± 13.25 years, 68% male) with an episode of pancreatitis, 632 (87.3%) had presented with a first episode (AP) and 92 (12.7%) with at least one prior episode (RAP). The incidence of severe pancreatitis was significantly less in RAP patients (10.9%) in comparison to AP patients (48.6%). The requirement of surgical intervention and mortality were less in patients with RAP (1.1 and 2.2%, respectively) compared to patients with AP (9.3 and 18%, respectively). The mean number of episodes per RAP patients was 2.97 ± 1.66 (range 2-10), and 64.1% had only two episodes. Regarding the etiology of RAP patients, biliary etiology (32.6%) and alcohol (30.4%) were the two most frequent factors, and no etiology could be identified in 19.6%.Patients with RAP had milder disease course and lesser mortality when compared to the initial episode of AP. Appropriate evaluation and dealing with etiological factors at the initial episode of AP can prevent a majority of RAP.

  View details for DOI 10.1002/jgh3.12060

  View details for PubMedID 30483578

  View details for PubMedCentralID PMC6207058

• Neutrophil gelatinase‐associated lipocalin: An early biomarker for predicting acute kidney injury and severity in patients with acute pancreatitis Siddappa , P., Kochhar , R., Sarotra , P., Medhi , B., Jha , V., Gupta , V. JGH . 2018 105- 10
• Application of diathermic dilator for negotiating near total antro-pyloric strictures Endoscopy Siddappa , P., Reddy , Y., Gupta , P. 2016: E365-6
• Colon and Gastric cancer in the elderly Textbook of Geriatrics Kochhar , R., Siddappa , P. Paras Medical Publisher . 2014: 687-690
• Mega stents - new option for management of leaks following laparoscopic sleeve gastrectomy Basha , J., Siddappa , P. Endoscopy. 2014 E49-E50
• Inflammatory gastric outlet obstruction after acute pancreatitis: a novel method of treatment Reddy , Y., Arunachalam , A., Siddappa, P. Gastrointestinal Endoscopy . 2014 775-776
• Screening for colorectal cancer: do we have a definitive answer? Siddappa , P., Dutta , U. National Medical Journal of India . 2013
• Extraintestinal manifestations of IBD: Indian Perspective ECAB Clinical Update: Gastroenterology- Inflammatory Bowel Disease Kochhar , R., Siddappa , P., Sinha , S. Elsevier . 2013: 120-134
• Melanoma of stomach Khaliq , A., Siddappa , P. J Gastrointest Cancer . 2012 630-3
• Evaluation of adefovir & lamivudine in chronic hepatitis B: correlation with HBV viral kinetic, hepatic-necro inflammation & fibrosis. The Indian journal of medical research Pradeep Kumar, S., Medhi, S., Asim, M., Das, B. C., Gondal, R., Kar, P. 2011; 133 (1): 50-6

  Abstract

  Chronic hepatitis B is an important cause of morbidity and mortality. We conducted a study comparing the efficacy of adefovir and lamivudine with respect to their impact on serum and hepatic viral DNA clearance, and improvement in hepatic necro-inflammatory score, in naive patients of chronic hepatitis B.This prospective randomized pilot study was conducted in Lok Nayak Hospital, New Delhi, involving 30 patients of chronic hepatitis B (both e antigen positive and negative); 15 were randomly selected to receive either adefovir or lamivudine for a period of 6 months. Quantification of serum and hepatic HBV DNA levels was done by real time PCR and liver biopsy was done at the beginning and end of 6 months.Serum ALT was elevated to 2 or more times normalized in both the groups. In the adefovir group, two patients became HBeAg negative. In the lamivudine group, one patient became HBeAg negative. After therapy HBV DNA was negative in 26.7 per cent patients from adefovir group and 13.3 per cent patients from lamivudine group. Serum HBV DNA levels were correlated with the hepatic levels before therapy (r=0.843; P<0.001) and after therapy (r=0.713, P<0.001) showing strong correlation. There was a median reduction of 1.92 and 2.06 log copies per ml in serum HBV DNA load after adefovir and lamivudine therapy, respectively. The mean reduction in the histology activity index (HAI) score was 2 and 1.53, fibrosis score was 2.33 and 3.06 after adefovir and lamivudine therapy respectively.Adefovir and lamivudine treatment caused biochemical and serological improvement when administered for about 6 months with significant reduction in HBV DNA, serum and hepatic viral load without completely clearing the virus from either serum or liver. It also helped in reduction of the necro-inflammatory and fibrosis score of patients with chronic hepatitis B. Our study also showed significant correlation between serum and hepatic HBV DNA levels both before and after therapy. There was not enough evidence to show therapeutic advantage of one drug over the other in any of the parameters measured.

  View details for PubMedID 21321419

  View details for PubMedCentralID PMC3100146

• Hepatic Hydrothorax Siddappa , P., Kar , P. Tropical Gastroenterology . 2009 135-141
• A case of primary Rectal Non-Hodgkin’s Lymphoma treated with chemotherapy Singla , R., Siddappa , P., Kar , P. Tropical Gastroenterology . 2008 227-29