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Background/Aims@#Pancreatic strictures in chronic pancreatitis are treated using endoscopic retrograde cholangiopancreatography (ERCP) with plastic stent placement. The management of recalcitrant strictures remains a challenge, with the use of a Soehendra stent retriever or a needle knife described in case reports. Here, we discuss our experience with dilation of dominant pancreatic strictures with a 6-Fr cystotome. @*Methods@#A retrospective review of an endoscopy database was performed to search for patients with pancreatic strictures recalcitrant to conventional methods of dilation in which a cystotome was used. Technical success was defined as the successful dilation of the stricture with plastic stent placement. Functional success was defined as substantial pain relief or resolution of pancreatic fistulae. @*Results@#Ten patients (mean age, 30.8 years) underwent dilation of a dominant pancreatic stricture secondary to chronic pancreatitis, with a 6-Fr cystotome. Seven patients presented with pain. Three patients had pancreatic fistulae (two had pancreatic ascites and one had a pancreaticopleural fistula). The median stricture length was 10 mm (range, 5–25 mm). The head of the pancreas was the most common location of the stricture (60%). Technical and functional success was achieved in all patients. One patient had self-limiting bleeding, whereas another patient developed mild post-ERCP pancreatitis. @*Conclusions@#The use of a 6-Fr cystotome (diathermy catheter) can be an alternative method for dilation of recalcitrant pancreatic strictures after the failure of conventional modalities.
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INTRODUCTION: Healthcare workers (HCWs) are at high risk of hepatitis B virus infection (HBI) and so the present study was carried out to assess the knowledge of HCWs in a tertiary care medical college about HBI and hepatitis B vaccine (HBV). METHOD: After obtaining approval from Institutional Ethics Committee and informed consent from the study participants, HCWs that included teaching faculty, resident doctors, medical students, nurses, laboratory technicians, administrative staff and support staff (ward boys, attendants and sweepers) were administered a validated questionnaire. Descriptive statistics was applied for the categorical variables and the Chi-square test of association was used to assess the statistical significance of variables. RESULTS: A total of 300 HCWs were recruited for the study. Although, the overall knowledge amongst all the HCWs was found to be 68%, only 35.3%HCWs knew the transmission risk by needle stick injury (NSI). Similarly, only 40% correctly knew the precautions to be taken for preventing an NSI and 17% for the steps to be taken to disinfect a blood splash. Almost 92.7% (278/300) HCWs were aware about the availability of a vaccine, of which only 41% (1123/300) knew that vaccine will not work in case the patient is already infected. When asked about the steps to be taken in case of an NSI in non-vaccinated HCWs, only 54.7% (164/300) replied about treatment with both immunoglobulin and vaccination. A total of 160 (53.3%) HCWs were found to be vaccinated. The most common reason for not taking vaccination included an improper understanding of HBV and the infection it causes. CONCLUSION: To conclude, the study highlights good knowledge about hepatitis B infection with requirement of more emphasis on the practical aspects of management in a case of NSI/blood splash and can guide to improve the vaccination status and knowledge of HBI amongst HCWs.
