Department Of Gastroenterology

The knowledge and technology in Gastroenterology has grown massively in the last two decades and has branched into various subspecialties like hepatology, pancreatology, functional bowel disorders with motility studies, therapeutic endoscopy and endoscopic ultrasound. Gastrointestinal services incorporate a joint medical and surgical approach for the prevention, diagnosis and treatment of gastrointestinal, liver and pancreatic disorders including cancer.

Uptill now such approaches were limited to tier 1 cities. However, we at UAIMS aspiring to make all those facilities at smaller cities and rural population at an affordable cost to whom access to big cities is just a dream. The department of Gastroenterology at UAIMS provides a comprehensive and state-of-the-art service by means of the outpatient and inpatient facilities. The department is manned by esteemed and experienced gastroenterologists, efficient medical officers, skilled and compassionate paramedical staff, and well-trained technicians. The aim of the department is to provide a patient-focused approach.

 

The UAIMS Endoscopy Services

We have state of art modular endoscopy suits with Olympus 190 processor for Diagnostic and therapeutic Endoscopy, Colonocopy, ERCP, EUS and 1st enter in entire Maharashtra to have Powerspiral enterosopy facility

What is an endoscopy?

An endoscopy is a procedure in which specialized instruments i.e. endoscope is used to view the internal organs. UGI endoscopy is done with gastroscope which is passed through the oral cavity and examination of the oesophagus, stomach and duodenum are done. Endoscopy can be done with or without the use of anaesthesia. Before endoscopy gargles of lignocaine liquid/lignocaine spray is given to numb the oral the cavity, so the patient will not feel any discomfort. Endoscopy is performed for diagnosis as well as for treatment. Predominantly this procedure is done on an out-patient basis. The healthcare staff will monitor your vital signs and keep you as comfortable as possible during as well as post-procedure.

When endoscopy is indicated?

These are the symptoms where endoscopy is indicated to diagnose certain conditions or diseases.

Reflux, heartburn, difficulty in swallowing, vomiting, coffee coloured vomitus or fresh blood in vomiting, in liver disease patients, to diagnose cancer of oesophagus and stomach, oesophagal, stomach and duodenal polyp (tumour).

Procedures are done with an endoscope

We have an expert team to do below mentioned procedure. Some of the procedures are done by the highly experienced consultant in that field.

  • Treatment of bleeding ulcer
  • Banding for oesophagal varices in liver disease
  • Removal of oesophagal and stomach polyp, small cancer
  • Removal of foreign body’s (coin, pins, button battery, needle, blade)
  • Treatment of reflux disease
  • Dilatation of oesophagal narrowing, stomach narrowing
  • Per Oral Endoscopic Myotomy (POEM) treatment for achalasia
  • Treatment for obesity

What are the preparations for endoscopy?

You will need to stop drinking and eating eight hours before your endoscopy. You will need to stop taking certain medication like anti-diabetic medication (insulin, tablets), blood-thinning medications on the day of your endoscopy. Blood thinners may increase your risk of bleeding if certain procedures are performed during the endoscopy. For high blood pressure, follow your doctor’s advice.

What are the complications of endoscopy?

There are no major complications of endoscopy. Post-procedure some patients may feel mild throat discomfort, chest pain.

 

The UAIMS Colonoscopy Services

The colonoscopy department of Asian Institute of Gastroenterology performs one of the largest numbers of colonoscopies per year in the world (more than 10 thousand colonoscopies per year) by experts in the field. Colonoscopy is a test which allows the doctor to look directly at the lining of the large intestine (the colon). Diagnostic colonoscopy is recommended for change in bowel habits, occult or frank blood in the stool, unexplained anaemia and as a screening test for colon cancer. In order to do the test, a colonoscope is carefully passed through the anus into the large intestine. The colonoscope is a long flexible tube, about the thickness of your index finger, with a bright light at its tip. The video camera on the colonoscope transmits images of the inside of the colon to a monitor allowing the physician to examine the lining of the colon checking for any disease or abnormalities. If necessary, polyps or other types of abnormal tissue can be removed through the scope during a colonoscopy. Tissue samples (biopsies) can be taken during a colonoscopy as well.

Diagnosis: Colonoscopy can help doctors diagnose the reasons for

  • Changes in bowel habits
  • Pain in Abdomen
  • Bleeding per rectum or evaluation of unexplained bleeding from the gastrointestinal tract
  • Unexplained weight loss
  • To evaluate abnormalities in the large intestine in other imaging like ultrasound and CT scan
  • Unexplained anaemia
  • Diarrhoea of unknown cause
  • Diagnosis and surveillance of colonic cancer
  • Colonoscopy can also detect inflamed tissue, ulcers (like in Inflammatory bowel disease or ulcerative colitis), and abnormal growths.

The procedure is used to look for early signs of colorectal cancer. The doctor can also take samples from abnormal-looking tissues during colonoscopy. The procedure, called a biopsy, allows the doctor to later look at the tissue with a microscope for signs of disease.

Chromo-endoscopy: A dye is sprayed over colon that will help to diagnose early tumours and helpful in colonic cancer surveillance especially in high-risk groups like patients with inflammatory bowel disease.
NBI (narrow band imaging): is a modality when applied with colonoscopy can help to differentiate malignant tumours from benign colonic tumours without the need for biopsy or can help to direct biopsies from specific sites so that diagnostic yield is high.

Treatment: Colonoscopy can help doctors with the following issues

  • Removal of polyps (polypectomy)
  • Removal of large polyps/ tumours by endoscopic mucosal resection(EMR) or endoscopic submucosal dissection (ESD) which was earlier thought to be only removable by surgery
  • Dilate narrowed segments (stricture dilation) of the large intestine and place metallic stents across them (colonic stenting)
  • Banding for haemorrhoids (piles banding)
  • Control of bleeding from ulcers, vascular malformation, growth or a tumour
  • Rectal foreign body removal
  • Palliative treatment for obstructing tumour ( metal stenting) or bleeding tumour ( laser, electrocoagulation, heater probe, injection)
  • Decompression of megacolon or volvulus

 

Interventions:

  • Polypectomy- polyps are removed by snare
  • Endoscopic Band Ligation (EBL) for piles- band applied for the eradication of piles
  • CRE (Controlled radial expansion) balloon dilatation for stricture dilatation
  • Argon Plasma Coagulation (APC)- bleeding vessels are coagulated
  • Endoscopic Mucosal Resection(EMR)- polyps are removed by lifting them up by sub-mucosal injection
  • Endoscopic Sub-mucosal Dissection (ESD)- tumours or polyps with deep extension are removed en-bloc or piecemeal with this procedure, surgery can be avoided.
  • SEMS (Self Expanding Metal Stent) placement- for obstructing cancerous growth that is not amenable to surgery, SEMS can be placed for symptomatic relief
  • Glue injection/ sclerotherapy for bleeding varices- in liver disease patients dilated veins (varices) which are bleeding can be obliterated by this technique

 

Enteroscopy

Enteroscopy is an endoscopic procedure for the diagnosis and treatment of diseases affecting small intestine, the part of the intestine which is beyond the reach of the standard upper GI endoscopy and colonoscopy. A flexible endoscope (enteroscopy) is inserted through the patient’s mouth (per oral or ante-grade enteroscopy) or anus (retro-grade enteroscopy) and almost whole of the small intestine can be reached.

The common indications for performing enteroscopy are a pain in the abdomen, obscure GI bleeding, diarrhoea and unexplained weight loss, where routine investigations including upper GI endoscopy and colonoscopy have failed to find the cause of symptoms. Enteroscopy with high definition imaging including narrow banding imaging is used to visualize lesions and take targeted biopsies in diseases like Crohn’s disease, small intestine polyps and tumours, lymphoma, celiac disease and other diseases affecting small intestine.

Enteroscopy is an effective therapeutic procedure used to treat diseases of the mall intestine. Enteroscopy can be used to dilate small bowel strictures, take out the foreign body, polypectomy (removal of polyps) and immediate control active bleeding from vascular lesions like angioectasias and dieulafoy’s lesions using argon plasma coagulation and hemoclip application and thus avoiding major abdominal surgeries.

Enteroscopy assisted ERCP is an advanced endoscopic procedure to treat diseases of the bile duct and pancreas. It is done in patients where standard ERCP is not feasible due to surgically altered anatomy like those patients who have previously undergone hepatobiliary, intestinal and bariatric surgery.

Patient preparation for enteroscopy is simple, the patient who is planned for retro-grade enteroscopy is advised to take laxative solution on the evening before and on the day of the procedure to clear the bowel, while the patient who is planned for ante-grade enteroscopy should have overnight fasting or minimum of 8 hours of nil by mouth.

Enteroscopy is a very safe procedure and associated with very low risk. Most of the procedures can be done as an out-patient procedure and the patient can expect to go home a few hours after the procedure. It is performed with conscious sedation (minimal anaesthesia), although some patients may require deep sedation also, depending upon the indication and therapeutic procedure being planned. Minor complications like irritation or pain at the injection site, allergic reaction to the anaesthetic drug used, mild pain abdomen after the procedure and minor bleeding at biopsy or polypectomy site can be managed easily. Although rare, one possible complication is a perforation, or tear through the wall of the bowel which may require abdominal surgery.

It is immense pleasure that we have the latest Spiral eneteroscope from Olympus-,Japan. With the help this state of art technology we can evaluate entire small bowel in most of the patients.

 

Hepatology

  • Colonic cancer surveillance- colorectal cancer is on the rise in Asian countries.
  • Surveillance is recommended in average and high-risk patients to detect this dreaded disease in the early stage which may help in endoscopic treatment avoiding surgery.
  • Surveillance of patients with IBD (Inflammatory Bowel Disease)- Patients with long-standing IBD are prone to develop colorectal cancer which can be screened by colonoscopy combined with chromo-endoscopy or NBI.
  • Early detection and characterization of premalignant colonic polyp followed by removal

Preventive Hepatology: Liver diseases are one of the most common causes of morbidity in the present world. Lifestyle changes and lack of physical exercise has given rise to an emerging epidemic called non-alcoholic fatty liver disease and these patients can progress to liver cirrhosis which is an end-stage liver disease. We actively try to detect these patients of NAFLD and also counsel patients who visit the hospital regarding steps to prevent fatty liver which includes dietary and physical activity counselling. Coupled with NAFLD, alcohol is another common cause of liver disease and us at UAIMS are committed to lending support to these patients to give up alcohol for a better life. Other preventable causes of liver diseases like hepatitis A and B can be prevented by vaccination and a society who is fully vaccinated against these preventable liver diseases is desirable. We at UAIMS are committed to trying to spread awareness for prevention of disease before they actually appear in the patients.

Liver Cirrhosis: Cirrhosis in common terms means a liver which has become small and stiff in contrast to the normal sized liver which is soft with low stiffness. Cirrhosis can occur due to multiple causes: alcohol, hepatitis B, hepatitis c and NAFLD being the commonest causes. Cirrhosis of the liver can lead to the development of jaundice, ascites (water in the abdomen), edema (leg swelling), varices (swelling of veins in the food pipe), gastrointestinal bleed (blood vomiting or black stool) and even progress to liver cancer. Though at present the curative treatment of advanced liver cirrhosis is liver transplantation, we at UAIMS are capable of dealing with all modalities of supportive treatment backed by a liver ICU and department of regenerative medicine which is investigating newer modalities of treatment for cirrhosis of the liver.

Viral Hepatitis: Affection of the liver due to multiple viruses like Hepatitis A, B, C and E can be managed and intact patients with hepatitis C with the newer medicines can now be totally cured of the disease. Hepatitis A and E are usually a self-limiting disease and are the commonest cause of jaundice. Patients of Hepatitis B are also managed by a group of highly trained and experienced doctors.

Alcoholic Liver Disease: Patients who have not yet developed cirrhosis is a reversible and treatable condition and these patients are effectively managed at our unit by a multidisciplinary effort of hepatology, nutrition and psych-social support system

Jaundice of Various Etiology: Other than the viral, other causes are also evaluated and treated at our centre. The state of art diagnostic back up helps in diagnosis rare causes of liver injury like autoimmune hepatitis, Wilson disease, Gilbert’s syndrome, drug induce liver injury etc which lead to proper management of these patients.

Fatty Liver: Both alcoholic and non-alcoholic etiology are managed by a combined approach of lifestyle modification, dietary changes and medications. We at UAIMS also do genetic testing for NAFLD to identify patients who are at increased risk of progression to cirrhosis of the liver and these patients have to be more aggressively managed.

UAIMS has a team of visiting liver transplant surgeons and there are plans to start in house Liver transplant in near future.

 

The UAIMS Pancreatology services

The Pancreas Clinic offers comprehensive services by experienced pancreatologists with long track records for patients with acute and chronic pancreatitis, pancreatobiliary cancers and pancreatic cystic disease. The services comprise comprehensive care including detailed workups, diagnosis, medical or/and surgical treatment, when indicated, on an outpatient as well as inpatient basis. We provide a unique hotline for our registered patients to contact the clinic staff directly in case of an urgent problem. All the newest and world class diagnostic and therapeutic (interventional) services, and screening, including preventive strategies for cancer, are available here. The centre has for many years undertaken research into the causative factors of pancreatitis and published books and research papers. We offer the patient all the current options in treatment with the patient’s perceptions in mind. Personal care, counseling, patient education, psychological support and empowerment makes this clinic unique in this category.

Diagnostic and Therapeutic Facilities
Facilities include Endoscopic retrograde cholangiopancreatography (ERCP), Multi-Slice CT scan, Magnetic resonance imaging (MRI), Magnetic resonance cholangiopancreatography (MRCP), pancreatic stenting, pseudocyst drainage, Endoscopic ultrasound (EUS), Endoscopic ultrasound-guided FNA (EUS-FNA), celiac plexus block, lithotripsy, etc. Comprehensive management of alcohol related pancreatitis, tropical pancreatitis, autoimmune, metabolic and drug induced pancreatitis etc is also available.

The highlight of department is the integration of clinical care of pancreatitis, care of pancreatic diabetes and its complications, advice on diet and life style during each visit, explaining the basis of the disease and the rationale for decision making and making the patient a full partner in the treatment of his/her disease. In this clinic the maximum emphasis is laid on the quality of life of the patient – it is totally patient oriented and not disease oriented

For pancreato biliary cancer
Diagnostic facilities available include non-invasive tumor markers, endoscopic ultrasound (EUS) and EUS —FNA apart from all established imaging modalities. Non-surgical management including biliary drainage and stenting, etc. is available. Evaluation and management of pancreatic cysts and cystic cancers is also undertaken. Excellent support is extended to the Pancreas Clinic by the pancreatobiliary surgeons from GI Surgery. This group of surgeons have a vast experience in hepato- pancreato-biliary surgery and routinely undertake all types of surgeries ranging from the simplest to the most complicated, including liver transplantation.

The UAIMS Gastrointestinal bleeding services

A dedicated team of endoscopists, gastrointestinal surgeons, interventional radiologists, and vascular surgeons are available around the clock for treating patients with upper or lower gastrointestinal bleeding. A fully-monitored emergency ICU service, an outstanding blood bank which provides blood component therapy, and a 24 hour endoscopic and surgical service ensure immediate control of massive bleeding. Complex diagnostic and therapeutic modalities often avoid the need for high-risk surgery.

The availability of all the investigational modalities within the hospital itself makes the UAIMS one of the best centres for evaluation of gastrointestinal bleeds. We aspire to raise unit to be a tertiary referral centre in the state of Maharshtra for this pathology. Patients presenting with GI bleeds are resuscitated in the intensive care setting if needed. A advanced in house blood bank that is capable of supplying large volumes of whole blood or its components even at short notice helps in the resuscitation of these patients.

The investigation required for each patient is decided after consultation between the surgeon, interventional radiologist and the medical gastroenterologist.

The availability under a single roof of all advanced imaging techniques like Upper GI Endoscopy, Colonoscopy, Enteroscopy, CT Scan, MRI Imaging, On-table Enteroscopy, Angiography and Nuclear Medicine scanning ensures that a patient will not need to be shifted out of the hospital for any evaluation.

Unlike many other centres, all these facilities are available round the clock at UAIMS. No time is lost in the evaluation and treatment of these patient.

 

The UAIMS Neurogastroenterology and GI motility

Neurogastroenterology and GI motility disorders are one of the leading causes of visits to Gastroenterologists.

Any alteration in the transit of gastrointestinal contents and secretions can be considered a motility disorder. These result in loss of coordinated muscular activity in the digestive system in a way that transit time is either hastened or slowed. In addition to diarrhoea, incontinence, and constipation, the manifestations of the motility disorders can include malnutrition, abdominal bloating, severe abdominal pain, gastroesophageal reflux, nausea, and intractable vomiting. In addition to imposing a heavy burden of illness, the GI motility disorders are attended by the decreased quality of life and work productivity, depression, weight loss and isolationism.

These are broadly called FGIDs (Functional Gastro-Intestinal Disorders). The genetic composition and interactions with the environment and one’s own microbiome influence susceptibility to disease, phenotypic expression and, importantly, patient behaviours.

 

Gastrointestinal Surgery:

Gastrointestinal Surgery dept deals with surgical problems starting from Esophagus upto Anal canal. Minimally invasive Laparoscopic and Conventional Open Surgeries are available for GI problems:

  • Strictures of Esophagus
  • Malignancy of Esophagus
  • Achalsia Cardia ( Inability of lower end esophagus to open)
  • Hiatus Hernia ( Herniation at Esophageal Hiatus)
  • Diseases of Stomach like Cancer, Chronic Ulcer, Volvulus, Gastric outlet obstruction, various tumors of Stomach
  • Diseases of Small & Large intestines like, Strictures, Polyps,Volvulus, Adhesions, Intususseption, perforation, Bleeding, Inflammatory diseases and Cancer etc
  • Diseases of Hepatobiliary system (Liver, GallBladder, Bile Duct) Liver tumors,
  • Plastic Surgery ( Aesthetic and Reconstructive)
  • Onco Surgery
  • Medical Oncology
  • Radiotherapy

Gastroenterology Consultants

DR. UDAYSINH PATIL
Dr. Udaysinh Patil
MD , DNB. DM, DNB( Gastro)
DR. SUJAY KULKARNI
Dr. Sujay Kulkarni
MD (Med) DNB (Gastro)

Flexible appointments and urgent care.

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