Regency Tower 2 Sarvodaya Nagar is a dedicated Gastro care center. Here emergency is open round the clock to take care of any type of Gastrointestinal disease emergency.
Dr. Ajmal Hasan is available at Regency Tower 2, Sarvodaya Nagar between 11 am to 4 pm and at Regency City Clinic PPN market Between 6 pm to 8 pm.
All Diagnostic and Therapeutic endoscopy, Radiological investigation like X-ray, Ultrasound, CT scan, Blood tests are available under a single roof at both places (tower 2 Sarvodaya Nagar and City clinic PPN market).
IPD/ Gastro ward:
Regency Tower 2 is a dedicated Gastro Care center. Here dedicated Gastro wards(General, and Private ) with all facilities and well-trained staff are available to take care of all types of Gastrointestinal disease patients.
Some Patients like Severe Acute, Pancreatitis, Acute Liver Failure, GI bleeding, Hepatic coma patients may require ICU care. Regency Tower 2 has dedicated Gastro ICU with all modern facilities and with round the clock critical care specialists available to take care of such patients.
Some patients of Acute or Chronic pancreatitis may develop fluid collections around pancreas. These fluid collection may be liquid only (called as Pseudo Cyst ) or may be having large amount of solid debris (called as walled of necrosis or WOPN) . These fluid collections may leads to many problems like persistent pain , vomiting, jaundice, inability to thrive . But most problematic is persistent infection which is not responding to even higher antibiotics also . Therefore removal of these collections from body becomes mandatory. For many years surgery was only option these collections but now Endoscopic or Endoscopic ultrasound (EUS) guided drainage has become Treatment of Choice for these collections. It drains collections internally in stomach or duodenum.
Advantages of EUS/Endoscopic drainage –
It has basic advantages over surgical drainage like –
(1) No incision or scar over skin as it drains internally
(2) Patient with infected collections are usually quiet sick and surgery may add further stress on body which may delay recovery. Therefore Endoscopic/EUS drainage prevents collateral damage of body done by surgery.
(3) These are day care procedures and patients can be discharged on same day.
(4) Less hospital stay/ Less cost.
Pancreatic Pseudo Cyst drainage –
Endoscopic or Endoscopic ultrasound (EUS) guide plastic stent placement is mostly sufficient to treat pseudocyst.
In view of significant solid debris EUS guided Lumen Apposing Metallic Stent (LAMS ) is the treatment of choice. It helps ur doctor to remove necrotic debris from your body which is the source of infection.
Endoscopic weight reduction (Bariatric Endoscopy) is a modern and rapidly growing branch. Endoscopic Bariatric procedures have some basic advantages over Bariatric Surgery like (1) Being incision and scar-free (2) Daycare procedure and patients can be discharged on the same day (3) Fewer chances of complications as related to surgery.
Among Various Endoscopic Bariatric procedures two most commonly used procedures are (1) Endoscopic Sleeve Gastroplasty (ESG) and (2) Intra Gastric Balloon Placement.
Endoscopic Sleeve Gastroplasty (ESG).
It is best suited for a person with a BMI between 28 to 42 but can be done in even higher BMI also.
This procedure is performed under general anesthesia. The average procedure time is 1.5 hrs only.
In this, an endoscope with a suturing device is passed in the stomach via mouth like any of the normal endoscopies. After passing in the stomach, the suturing device stitches your stomach from inside and reduces one-third of stomach size without removing any part of your stomach and also without any incision or future scar on your skin.
It encourages weight loss by restricting the stomach size so it holds only a limited amount of food. This helps patients
to eat less without hampering the normal digestive process. The patients feel full after a smaller meal and feel hungry after longer intervals.
How Effective is Endoscopic Sleeve Gastroplasty (ESG )
Average Total Body Weight(TBW) loss at 6 months post-procedure is about 20 percent.
Average Excess Weight Loss (EWL ) at 6 months post-procedure is 40 percent.
Advantages of Endoscopic Sleeve Gastroplasty (ESG)
• Reduced stomach size makes you feel full sooner.
• Normal functions of the stomach are retained.
• Simpler than other bariatric surgeries.
• Can be performed through the mouth thereby an incision-less surgery
• Shorter hospitalization stay
• Less operative time
• No implant used as in lap band surgery.
• Minimal postoperative pain and discomfort.
• Shorter recovery time
• Does not preclude further weight loss intervention including surgery if needed later.
This procedure is approved for a person with a BMI between 30 to 40.
It takes just half an hour to place a balloon in your stomach.
In this procedure with the help of a normal endoscope, water, or gas-filled silicons balloon is placed in the stomach.
This helps you lose weight by limiting how much you can eat and making you feel fuller faster and therefore you have early satiety with lesser food intake only. The balloon is not for permanent use and it is mostly removed after 6 to 12 months once you have achieved targeted weight loss.
How Effective is Intra Gastric Balloon (IGB )
On an average 6 month after procedure Total Body Weight (TBW) loss is 7 to 15 percent and Excess Weight Loss (EWL) is 30 to 40 percent.
For past several decades conventional endoscopies are being done in which endoscope runs only in the lumen of GI tract. But recently availability of ultramodern endoscopes and instruments has made it possible to insert the endoscope between the layers of GI tract wall. In this an artificial space in created between the layers of GI tract wall, which is called Third Space. Endoscope is inserted in this Third space to perform various type Procedures which are otherwise difficult to treat by surgery.
Commonly used Third Space Endoscopy procedures are:
(1) E – POEM – for Achalasia cardia
(2) Z – POEM – for Zenker Diverticulum
(3) G – POEM – for Gastroparesis
(4) STER – For Esophageal sub epithelial tumors
(5) POETRE – for esophageal Stricture
Advantages of Third Space Endoscopy Procedures:
(1) Like any of the endoscopic procedure these are incision and scar free.
(2) Short Hospital stay/ Less cost
(3) Many difficult surgeries can be avoided by using third space endoscopy technique.
Motorized Power Spiral Enteroscopy
Small-bowel disorders remain a diagnostic and therapeutic challenge due to intestinal length. The Novel Motorized Spiral Enteroscopy is an ultramodern technique to perform diagnostic and therapeutic procedures in small bowel without surgery.
Indication for Motorized Spiral Power Enteroscopy
GI bleed of suspected small intestine origin
Evaluation of stricture in the small intestine
Tumor of the small intestine
Evaluation of small intestine in a patient with Crohn’s disease
During spiral enteroscopy, a biopsy can be taken from suspicious areas and end therapy can be done for the bleeding.
How Spiral Enteroscopy is done
Spiral enteroscopy can be performed in as little as twenty minutes but may require more time depending on your condition.
The procedure will be performed with you lying on your left side.
The physician will usually administer something to help you relax and remain comfortable throughout the procedure and medications will be administered through an intravenous line.
None of these activities are painful, since the lining of the intestine does not experience pain.
Upper GI endoscopy is a procedure to evaluate the mucosa of esophagus, stomach and duodenum.
Endoscope is introduced by the mouth after sedation, mucosal appearance of esophagus, stomach and duodenum is evaluated and biopsy can be taken from suspicious areas, and endotherapy can be done for the bleeding lesions.
Endoscopy is extremely safe procedure without any complications. It is usually done on outpatient basis and patient can be discharged in 2-3 hours
Indications of UGI endoscopy
Therapeutic proceures that can be dine during endoscopy are
|Esophageal cancer||Clip applied on bleeding ulcer||SEMS placed in esophagus|
Colonoscopy is a test for evaluation of large intestine, and the terminal portion of small intestine. Procedure is performed under anaesthesia. During colonoscopy, colonoscope is introduced through the anus and gradually advanced further.
During colonoscopy, Biopsy can be taken from suspicious areas, or endotherapy can be done for the bleeding lesions
Indications for colonoscopy are
Therapeutic indication for colonoscopy are
|Rectal polyp||Ulcerative colitis||Crohn's disease|
Endoscopic retrograde cholangiopancreaticography (ERCP) is a procedure for treatment of biliary and pancreatic diseases
ERCP is performed by the oral route after sedation. During ERCP, bile duct and pancreatic ducts are evaluated after injection of contrast agent, and various therapeutic procedures can be performed
During ERCP stones can be removed form CBD or pancreatic duct and stents can be placed in CBD for treatment of jaundice and in MPD for pain relief
Indications of ERCP are
ERCP is a safe procedure in expert hands, and is performed on day care basis, however serious complications like cholangitis, pancreatitis, perforation can occur in 1-3% of cases, which may require longer hospital stay
|SEMS placed in CBD||Plastic stent placed in CBD||CBD stone removal|
EUS is ultrasound of internal structures surrounding the GI tract with the help of endoscope. EUS provides excellent resolution of pancreas, biliary system and the mediastinum.
EUS is performed by oral route after conscious sedation.
During EUS, sample can be taken from the nodes in mediastinum, tumor of pancreas and bile duct. With the help of endoscopic ultrasound various collections can be drained internally in the stomach or rectum and the major surgeries can be avoided.
Indications of EUS are
EUS examination showing node in the mediastinum
Liver biopsy is done for the diagnosis of various liver ailments, during liver biopsy a small piece of liver is taken for the microscopic examination.
Indications of liver biopsy
Liver biopsy is a is a safe procedure Severe complication can occur in 1 in 50,000 procedures
Fibroscan is a new technology for the assessment of severity of liver disease, and is safe test which is performed by putting a probe on skin of upper abdomen, and there are no complications of fibroscan.
For assessment of severity of liver disease, Fibroscan is replacing the liver biopsy.
Double balloon enteroscopy (DBE) is a procedure for evaluation of the small intestine
DBE is performed after sedation, enterosocpe is introduced through the mouth or anal route. Over the scope, overtube is passed for deep intubation of small intestine
Indications of double balloon enteroscopy are
During double balloon enteroscopy, biopsy can be taken from suspicious areas and endotherapy can be done for the bleeding lesions
Capsule endoscopy is non invasive test, which does not require any sedation For capsule endoscopy, patient swallows a small capsule, capsule has inbuilt camera, which captures and send the images of small inetstine to external data recorder, which are later studied for the evaluation of small intestine
Capsule should not be used, if there is suspicion of stricture in small intestine Moreover, tissue can not be obtained from diseased areas and endotherapy can not be done.
Capsule is passed out later in the stool, and it is not required to retrieve the capsule
Manometry is the study where a pressure sensing thin probe is passed from the nose or anus to study the pressure of esophagus, lower esophageal sphincter, rectum and anal canal
Esophgeal manometry is performed by nasal route, to study the pressure in esophagus and lower esophageal sphincter
Indication of esophageal manometry are
Anorectal manometry is done by the anal route.
Indications of anorectal manometry are
24 hour pH study is indicated in patients with suspected gatroesophageal reflux disease. 24 hour pH study is an ambulatory study, where pH probe is passes through the nose to lower esophagus, probe has to be kept in situ for 24 hours. All the reflux episodes from stomach to esophagus leads to change in esophageal pH, which are sensed by pH probe, and are recorded in data recorder, which is later studied