Browsing by Author "Lamsal, Manoj"
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Publication Clinical Profile and Endoscopic Management in Patients with Choledocholithiasis(Nepal Health Research Council, 2024) Lamsal, Manoj; Jha, Anurag; Kafle, Brindeswari; Hamal, Rabin; Sherpa, Tshering Wangdi; Kafle, Pradip Kumar; Bhattarai, Tulsi Ram; Bhusal, Mohan; Koirala, Dinesh; Pathak, RahulBackground: Common bile duct stones is a common medical problem that are usually seen in association with gallstone disease. Endoscopic management of Common bile duct stones involves doing Endoscopic retrograde cholangiography for bile duct clearance which is the primary therapeutic modality of choice. This prospective study was done to identify the clinical characteristics and outcome of patients presenting with Common bile duct stones undergoing Endoscopic retrograde cholangiography. Methods: A prospective observational study was conducted on all patients undergoing Endoscopic retrograde cholangiography in department of Gastroenterology, Tribhuvan University Teaching Hospital, for management of diagnosed or suspected choledocholithiasis from April 2023 to March 2024. Patient demographics, clinical characteristics, Endoscopic retrograde cholangiography findings and post procedure outcome data were collected and analysed. Results: A total of 110 patients (61.8% male and 38.2% female) were included in the final analysis. Successful clearance of Common bile duct was obtained in 76.4% patients with overall adverse events of 18% related to the procedure. Among patients undergoing the procedure, 16.4% couldn’t be managed with Endoscopic retrograde cholangiography and were referred for surgical management. Conclusions: Endoscopic management in form of Endoscopic retrograde cholangiography is a safe and effective method to manage patients with Common bile duct stones. Keywords: Common bile duct calculi; endoscopic sphincterotomy; ERCP.Publication Efficacy of Lactulose and Polyethylene Glycol in the Treatment of Hepatic Encephalopathy(Nepal Health Research Council, 2025) Pathak, Rahul; Lamsal, Manoj; Bhusal, MohanBackground: Hepatic encephalopathy presents a significant clinical challenge in individuals with advanced liver dysfunction, manifesting as confusion, altered consciousness, and personality changes. This study aimed to compare the efficacy of lactulose and polyethylene glycol in managing Hepatic encephalopathy. Methods: The study is conducted at Tribhuvan University Teaching Hospital in Nepal; the study enrolled 45 cirrhotic patients with altered mental status in each study group. Ethical approval and informed consent were obtained. The basic demographic and clinical data were collected, including laboratory investigation and precipitating factors for Hepatic encephalopathy. The severity of Hepatic encephalopathy was assessed using the West Haven Criteria. Results: In this study there was significant difference between two groups in terms of mean time taken for complete resolution of hepatic encephalopathy, with mean of 2.98 ± 2.129 days in Polyethylene Glycol group compared to mean of 4.67 ± 3.076 days in Lactulose group, with a significant p-value of 0.004. There was also significant difference in length of hospital stay between two groups, with a mean hospital stay of 6.36 ± 3.654 days in Polyethylene Glycol group compared to 9.70 ±5.388 days in Lactulose group, with a significant p-value of 0.001. Conclusions: In conclusion, polyethylene glycol showed promising results in the treatment of Hepatic encephalopathy compared to lactulose polyethylene glycol. demonstrated an improvement and quicker resolution of Hepatic encephalopathy symptoms, highlighting its potential as a cost effective and safe alternative for managing Hepatic encephalopathy in cirrhotic patients. Keywoards: Hepatic encephalopathy; lactulose; polyethylene glycol.