Browsing by Author "Purbey, BK"
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Publication First Successful Independent Peroral Endoscopic Myotomy (POEM) for Achalasia Cardia: A Milestone Case Report from Nepal(Kathmandu University, 2025) Purbey, BK; Karki, S; Khanal, A; Khadka, D; Singla, V; Adhikari, SABSTRACT Achalasia cardia is an uncommon esophageal motility disorder characterized by failure of relaxation of the lower esophageal sphincter and loss of peristalsis in the lower part of the esophagus. Peroral Endoscopic Myotomy (POEM) has emerged as a minimally invasive intervention equivalent to Heller myotomy and an effective treatment modality. We present the first successful solo peroral endoscopic myotomy procedure performed in Nepal by an interventional gastroenterologist, who has managed a 45-year-old patient with long-standing dysphagia and a history of failed pneumatic dilatation with success. The procedure was uneventful. The patient showed symptomatic improvement postoperatively with minimal reflux. This case highlights the feasibility and safety of independently performed peroral endoscopic myotomy in a resource-limited setting. It shows the diaspora of interventional gastroenterology in Nepal and begins a new era for the same. KEY WORDS Achalasia cardia, Dysphagia, Eckardt score, Peroral endoscopic myotomy (POEM)Publication Outcomes of Endoscopic Sphincteroplasty Using Large Balloon Dilatation for Difficult Common Bile Duct Stone Removal at Dhulikhel Hospital(Kathmandu University, 2019) Purbey, BK; Gurung, RB; Panday, R; Shrestha, A; Shah, RABSTRACT Background Endoscopic sphincteroplasty (ESPT) using a large Controlled Radial Expansion (CRE) Wire guided balloon dilatation has gained acceptance in removing a difficult common bile duct (CBD) stones. Objective To evaluate effectiveness and complications of removing large and difficult bile duct stones with sphincterotomy combined with large balloon dilatation. Method A total of 132 patients, from February 2014 to June 2017, who had biliary ductal calculus which was either greater than 15 mm or difficult to remove with standard technique, underwent Endoscopic Retrograde Cholangiopancreaticography (ERCP) with Endoscopic sphincteroplasty using a large Controlled radial expansion wire guided balloon dilatation. The success rate of complete stone clearance and post Endoscopic Retrograde Cholangiopancreaticography complications were analyzed. Result There were 48 (36.4 %) male and 84 (63.6%) female patients with mean age of 55.48 ± 16.36 years. Stones were removed with sphincteroplasty in first attempt in 90 out of 132 (68.2%) patients, 26 out of 37 (70.27%) patients in second session and in all 7(100%) patients in third attempt. Five (11.90%) patients were lost to follow up and 4 were advised for surgery because of failure to remove stones by sphincteroplasty. Overall success of endoscopic sphincterotomy and large balloon dilatation in our study was 93.18%. Complications were seen in 17 (13.6%) patients; bleeding seen in 9 (6.8%) patients and mild pancreatitis in 8 (6.1%) patients. None of the patients had severe pancreatitis or perforation secondary to the procedure. Conclusion Endoscopic sphincteroplasty after sphincterotomy is an effective and safe technique for a difficult common bile duct stone removal. KEY WORDS Common bile duct stone, Controlled radial expansion, Endoscopic sphincteroplastyPublication The Etiology of Upper Gastrointestinal Bleeding in Patients with Liver Cirrhosis in Dhulikhel Hospital(Kathmandu University, 2017) Purbey, BK; Gurung, RB; Panday, R; Acharya, B; Mehta, RKABSTRACT Background Acute upper gastrointestinal bleeding is a serious medical problem in cirrhotic patients. Patients with cirrhosis may develop upper gastrointestinal bleeding from a variety of lesions, including those due to portal hypertension, namely gastroesophageal varices and portal hypertensive gastropathy and other lesions as seen in the general population. Objective To investigate the etiology of upper gastrointestinal bleeding in liver cirrhotic patients. Method A retrospective review of 72 patients with liver cirrhosis and upper gastrointestinal bleeding from January 2013 to March 2016 was carried out at Dhulikhel Hospital. Child Pugh score was used to assess severity. Endoscopic diagnosis was documented. Result Out of 72 patients, 56 (77.8 %) were male and 16 (22.2%) were female. The most common age group was 30-42 years age. Fifty four cases of cirrhosis were associated with alcohol consumption. The Child-Pugh score was A in 20 patients (27.8%), B in 15 patients (20.8%) and C in 37 patients (51.4%). A combination of alcohol consumption and HCV infection was significantly associated with a higher Child-Pugh score (p=0.031). Twenty six (36.11%) patients had esophageal varices as cause of bleeding on endoscopic examination while 29(40.28%) had varices and other lesions identified at endoscopy. Of these 29 patients, 18 were found to have bled from esophageal varices, and 11 were found to have bled from coexisting lesion. Conclusion We found that variceal bleeding was the commonest cause of bleeding in cirrhotic patients, with 55 (78.5%) having varices and 44 (61%) actually bleeding from varices. KEY WORDS Alcohol, Cirrhosis, Endoscopy, Non-variceal upper gastrointestinal hemorrhage, Variceal bleeding