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Patients Corner:


Spectrum of Services Available:

Diagnostic & Therapeutic Upper Gastrointestinal Endoscopy (Oesophagogastro-duodenoscopy)

Endoscopic examination of food pipe, stomach, small intestine

Diagnostic & Therapeutic Lower Gastrointestinal Endoscopy (Ileo-Colonoscopy)

Endoscopic examination of large intestine

Diagnostic & Interventional Endoscopic Ultrasound (EUS)

For Cancers of food pipe, stomach, gall bladder,pancreas & for jaundice and pancreatitis

Intraductal Biliary and Pancreatic Endoscopic Ultrasound

For Cancers of bile ducts and pancreas

Advanced Therapeutic & Palliative ERCP

Treatment of obstructive jaundice due to stones or Cancers of biliary system or pancreas/ treatment of chronic pancreatitis

Diagnostic & Therapeutic Single Balloon Enteroscopy

For diseases of small intestine- bleeding/tumors

Paediatric Endoscopy

Endoscopy in children for recurrent vomiting foreign body, bleeding in stools & pancreatitis

Endoscopic Treatment for Obesity

Intragastric Balloon Placement

G.I. Physiology & Motility studies / Capsule Endoscopy

Difficulty in swallowing and acid reflux.
Click Here to understand the G I Physiology

IBD / IBS Clinic

For gas in the stomach, constipation, diarrhea, lower abdominal pain and blood/mucus in stools

Liver Clinic

Consultation in Hepatology - (for liver diseases).
Click Here to understand the Liver Clinic

Oncology Clinic

Multidisciplinary Team Consultation in G.I. Oncology (for Cancers of food pipe, stomach, small intestine, large intestine, liver, gall bladder, bile ducts & pancreas)

Pancreas Clinic

Multidisciplinary Team Consultation and Endoscopic Diagnosis and Treatment of Pancreatic Diseases.
Click Here to understand the Pancrease

Interventional Radiological Procedures on Full DSA equipment for G.I. & Hepato

Biliary disorders

Consultation in Gastroenterology

For any diseases related to Gastrointestinal tract (food pipe, stomach, small intestine, large intestine, gall bladder, liver and pancreas)

Emergency endoscopic services available

For any diseases related to Gastrointestinal tract (food pipe, stomach, small intestine, large intestine, gall bladder, liver and pancreas)

Capsule Endoscopy

Capsule Endoscopy lets your doctor examine the lining of the middle part of your gastrointestinal tract, which includes the three portions of the small intestine (duodenum, jejunum, ileum).

Digestive Endoscopic Resection

Click Here to understand the Digestive Endoscopic Resection

Health Check Ups

Click Here to understand the Health Check Up`s

Emergency endoscopic services available
Mediclaim facilities available. Click Here For an Appointment

Basic Information:

What is an Endoscope?

An endoscope is a long, narrow, thin flexible tube containing a light and a camera at the tip with controls at the other end. The camera transmits high definition (HD) images of your digestive tract to a HD television monitor which enables the doctor to view the entire gastrointestinal tract in real time. These images can also be recorded and printed.

The endoscope also has a working channel through which fine, delicate instruments can be passed to take biopsies or to treat the necessary various diseases of the gastrointestinal tract, pancreas, pancreatic duct, gall bladder, bile ducts, liver, small intestine and the large intestine.

There are various endoscopes like the Gastroscope, Colonoscope, Duodenoscope, Echo-endoscope and the Enteroscope.

What is an Endoscopy?

An Endoscopy is a procedure done to view the entire digestive tract non-surgically through the use of an endoscope which can be inserted through the mouth and down the throat or up the rectum and into the large intestine.

Indications for an Endoscopy

Dyspepsia

Acidity/Bloating/Gas

Dysphagia

Difficulty in Swallowing

Foreign Body Removal

Haemetmesis

Blood in Vomitus

Malena

Dark/Black stools

Unexplained Anaemia

Occult GI bleed

Upper/Lower Abdominal Pain

Diarrhea/Colitis Dysphagia

Blood/Mucus in stools

Constipation

Detection of Gallbladder Stones and Tumors

Jaundice

Detection of Common Bile Duct (CBD) Stones

Pancreatitis

Acute/Chronic

Detection of Pancreatic Duct Stones

Abdominal Complaints with Unexplained Weight Loss

Suspected/Diagnosed Gastrointestinal Cancers

Suspected/Diagnosed Cancer of Pancreas

Fever of Unknown Origin with Lymphnodes

Diagnosis of Abdominal TB/Mediastinal TB Nodes

Liver Diseseas

Acute/Chronic

Morbid Obesity

Upper G I Endoscopy

What is Upper G I Endoscopy?

Endoscopic examination of the esophagus (Food pipe), stomach and duodenum( first part of small intestine) with necessary interventions, if required.

What are the basic signs & symptoms for requiring an Upper G I Endoscopy?
  • Dysphagia - difficulty in swallowing

  • Dyspepsia - acidity/gaseous bloating/acid reflux

  • Persistent isolated nausea or vomiting

In the event of persistent isolated nausea or vomiting for more than 2 days, investigation of the upper gastrointestinal tract is justified after any nongastrointestinal origin and acute intestinal obstruction has been eliminated.

What are the other indications for an Upper Gastrointestinal Endoscopy?
  • Patients aged above 45 years and/or if there are any warning indications such as anaemia (drop in heamoglobin), difficulty in swallowing, weight loss or any other warning signs and symptoms.

  • Patients aged below 45 years with no warning signs or symptoms - positive diagnostic test for Helicobacter Pylori (a micro organism which only survive in the stomach, which can ultimately cause ulcers) – when symptomatic treatment has failed/recurrence occurs at the end of treatment.

  • Chronic anaemia and/or iron deficiency anaemia after any non-gastrointestinal origin has been eliminated

  • Acute gastrointestinal bleeding or black colored stools secondary to bleeding originating in the upper gastrointestinal tract

  • Gastro-esophageal reflux (GORD/GERD) with warning signs (weight loss, dysphagia, bleeding, anaemia), or if the patient is aged over 50 years/recurrence on withdrawal of treatment or resistance to medical treatment.

How does one prepare for an endoscopy?
  • Do not eat or drink for at least 6 hours prior to the procedure

  • Inform your doctor if you have any allergies, diabetes, heart, respiratory, hypertensive, blood thinning medications, past endoscopies or any other medical problem

  • Patient is to be accompanied with a caregiver/relative

What will it be like when you arrive at Endoscopy Asia for an Upper G I Endoscopy?
  • Patient will be required to come with all your previous investigations and files relating to the current problem.

  • Doctor will give a detailed consultation regarding the probable cause of the problem and recommend the required investigation/endoscopy and that you would be made aware of the treatment options and possible risks involved and a given consent form to be signed prior to the endoscopy

  • Patient will be taken to the procedure room and made comfortable. The nursing staff will prepare the patient with the necessary IV cannula and then spray some anaesthetic agent onto the back of the throat to make it numb prior to the procedure.

  • Patient will be asked to bite on a plastic mouth guard to protect the teeth as well as the endoscope from being bitten during the procedure. The endoscope will not interfere with your breathing.

  • The Anaesthetist/Doctor/Nurse will administer a light sedative intravenously through the IV line such as midazolam, fentanyl or propofol in order to have a smooth, comfortable and a painless endoscopic experience for the patient

  • Doctor will place the thin flexible tube like endoscope through the mouth guard, into the mouth and gently guide the endoscope to move down the esophagus through to the stomach and into the small intestine.

  • This will enable him to examine the upper digestive tract and if required to do a biopsy and the necessary interventional treatment to solve any problems that may be seen.

  • The Endoscopic procedure takes approximately 5 – 10 min.

What will happen after the procedure?
  • Patient will be taken to the recovery room where the blood pressure and heart rate is monitored while they rest and a slow drip of IV fluids given

  • Patient will generally wake up within ½ hour not realizing that the procedure has already been done and may experience mild disorientation upon waking which will soon pass.

  • Patient may feel slightly bloated which is normal and this sensation will disappear in a few hours.

  • Patient will be able to resume normal regular diet, medications and also be able to return to work on the same day after a few hours of rest in most cases.

What are the risks involved?
  • This procedure has a low (0.2%) risk of serious complications.

  • Potential serious complications include a tear or hole in the lining of the digestive tract called a perforation. Rates of perforations are in the order of less than 1 in 2000 upper endoscopies.

  • Bleeding complications may be treated immediately during the procedure. Delayed bleeding may also occur at the site of a polyp removal up to a week post procedure and a repeat procedure can then be performed to treat the bleeding site.

  • Less serious complications would include cardiopulmonary complications such as temporary drop in blood pressure and oxygen saturation. In rare cases, more serious cardiopulmonary events such as a heart attack or stroke may occur but these often occur in critically ill patients with multiple risk factors.

Images

Normal Esophagus

Fundus of stomach

Inlet patch in upper esophagus

Inlet patch seen on NBI

Severe reflux esophagitis (GERD)

Barrett`s esophagus-White light endoscopy

Barrett`s esophagus- NBI

Erosive gastritis

Esophageal Candida (NBI View)

Gastric polyp

Gastric Ulcer with visible vessel

Haemoclip applied on visible vessel

Normal duodenum

Duodenal Ulcer

Duodenal Ulcer with adherent clot

Chronic duodenitis

Angiodysplasia at D-J Flexure

Angiodysplasia seen on NBI

Watermelon stomach

APC of watermelon stomach

Band ligation for esophageal varices

Esophageal stent for Cancer esophagus

Foreign body-Coin removed from stomach

Foreign body-Denture removed

Capsule Endoscopy

What is Capsule Endoscopy?
Capsule Endoscopy lets your doctor examine the lining of the middle part of your gastrointestinal tract, which includes the three portions of the small intestine (duodenum, jejunum, ileum). Your doctor will give you a pill sized video camera for you to swallow. This camera has its own light source and takes pictures of your small intestine as it passes through. These pictures are sent to a small recording device you have to wear on your body. Your doctor will be able to view these pictures at a later time and might be able to provide you with useful information regarding your small intestine
Why is Capsule Endoscopy Done?
Capsule endoscopy helps your doctor evaluate the small intestine. This part of the bowel cannot be reached by traditional upper endoscopy or by colonoscopy. The most common reason for doing capsule endoscopy is to search for a cause of bleeding from the small intestine. It may also be useful for detecting polyps, inflammatory bowel disease (Crohn’s disease), ulcers, and tumors of the small intestine.
How Should I Prepare for the Procedure?
An empty stomach allows for the best and safest examination, so you should have nothing to eat or drink, including water, for approximately twelve hours before the examination. Your doctor will tell you when to start fasting.

Tell your doctor in advance about any medications you take including iron, aspirin, bismuth subsalicylate products and other over-the-counter medications. You might need to adjust your usual dose prior to the examination.

Discuss any allergies to medications as well as medical conditions, such as swallowing disorders and heart or lung disease.

Tell your doctor of the presence of a pacemaker or defibrillator, previous abdominal surgery, or previous history of bowel obstructions in the bowel, inflammatory bowel disease, or adhesions.

Your doctor may ask you to do a bowel prep/cleansing prior to the examination.
What Can I Expect During Capsule Endoscopy?
Your doctor will prepare you for the examination by applying a sensor device to your abdomen with adhesive sleeves (similar to tape). The pill-sized capsule endoscope is swallowed and passes naturally through your digestive tract while transmitting video images to a data recorder worn on your belt for approximately eight hours. At the end of the procedure you will return to the office and the data recorder is removed so that images of your small bowel can be put on a computer screen for physician review.

Most patients consider the test comfortable. The capsule endoscope is about the size of a large pill. After ingesting the capsule and until it is excreted you should not be near an MRI device or schedule an MRI examination.
What Happens After Capsule Endoscopy?
You will be able to drink clear liquids after two hours and eat a light meal after four hours following the capsule ingestion, unless your doctor instructs you otherwise. You will have to avoid vigorous physical activity such as running or jumping during the study. Your doctor generally can tell you the test results within the week following the procedure; however, the results of some tests might take longer.
What are the Possible Complications of Capsule Endoscopy?

Although complications can occur, they are rare when doctors who are specially trained and experienced in this procedure perform the test. There is potential for the capsule to be stuck at a narrowed spot in the digestive tract resulting in bowel obsctruction. This usually relates to a stricture (narrowing) of the digestive tract from inflammation, prior surgery, or tumor. It’s important to recognize obstruction early. Signs of obstruction include unusual bloating, abdominal pain, nausea or vomiting. You should call your doctor immediately for any such concerns. Also, if you develop a fever after the test, have trouble swallowing or experience chest pain, tell your doctor immediately. Be careful not to prematurely disconnect the system as this may result in loss of pictures being sent to your recording device.

Capsule endoscopy may also be called:
  • capsule enteroscopy

  • wireless capsule endoscopy

Capsule endoscopy allows for examination of the small intestine, which cannot be easily reached by traditional methods of endoscopy

Colonoscopy

What is a Colonoscopy?

Colonoscopy is a minimally invasive endoscopic examination of the large colon and the distal part of the small bowel with a light and a camera on the tip of the flexible tube (Colonoscope) passed through the anus. It provides a visual diagnosis (e.g. inflammation, ulceration, bleeding, polyps, tumors etc) and grants the opportunity for biopsy of suspected lesions and endoscopic treatment of the various pathologies of the large intestine (colon).

What are the reasons for a Colonoscopy?
  • Gastrointestinal hemorrhage Gastro intestinal bleeding or gastro intestinal hemorrhage describes every form of hemorrhage (loss of blood) in the gastrointestinal tract, from the pharynx to the rectum. The degree of bleeding can range from nearly undetectable to acute, massive, life-threatening bleeding unexplained changes in bowel habit or suspicion of malignancy.

  • Rule out cancerous growths in the colon, rectum and appendix It is the third most common form of cancer and the second leading cause of death amongst cancers in the western world. Many colorectal cancers are thought to arise from a polyp in the colon . These mushroom-like growths are usually benign, but some may develop into cancer over time. The majority of the time, the diagnosis of localized colon cancer is through a colonoscopy

  • Inflammatory bowel disease In older patients (sometimes even younger ones) an unexplained drop in hemoglobin is an indication to do a colonoscopy, usually along with an OGD (gastroscopy), even if no obvious blood has been seen in the stool (faeces).

  • Positive Faecal Occult Blood Test Faecal occult blood test is a quick test which can be done to test for microscopic traces of blood in the stool. A positive test is almost always an indication to do a colonoscopy. In most cases the positive result is just due to hemorrhoids; however it can also be due to polyps (which are easily removed during the colonoscopy procedure), diverticulosis, inflammatory bowel disease (Crohn's disease/ulcerative colitis/tubercular ulcers), or colon cancers.

Who should consider a colonoscopy?

Due to the high mortality associated with colon cancer and the high effectivity and low risks associated with colonoscopy, it is now also becoming a routine screening test for people 45 years of age or older. Subsequent re-screenings are then scheduled based on the initial results found, with a five or ten year recall being common for colonoscopies that produce normal results.

How does one prepare for a Colonoscopy?

The patient is required to follow a low fibre/clear fluid diet one day prior. And on the day of procedure the patient is given a solution of polyethylene glycol and electrolytes with approximately 2 litres of fluid which will initiate the movement of bowels and thoroughly cleanse the bowels. The colon must be free of solid matter in order to have a clear vision of the large bowel and part of the small bowel.

What will it be like when you arrive at Endoscopy Asia for a Colonoscopy?
  • Patient will be required to come with all the previous investigations and files relating to the current problem.

  • Doctor will give a detailed consultation regarding the probable cause of the problem and recommend the required investigation/endoscopy and that you would be made aware of the treatment options and possible risks involved and a given consent form to be signed prior to the endoscopy.

  • Patient will be taken to the procedure room and is required to change clothes and made comfortable. The nursing staff will then prepare the patient with the necessary IV cannula

  • The Anaesthetist/Doctor/Nurse will administer a light sedative intravenously through the IV line such as midazolam, fentanyl or propofol in order to have a smooth, comfortable and a painless colonoscopic experience for the patient.

  • The first step is usually a digital rectal examination, to examine the tone of the sphincter and to determine if preparation has been adequate. The endoscope is then passed though the anus up to the rectum, the colon (sigmoid, descending, transverse and ascending colon, the caecum), and ultimately the terminal ileum. The endoscope has a movable tip and multiple channels for instrumentation, air, suction and light. The bowel is occasionally insufflated with air to maximize visibility. Biopsies are frequently taken for histology.

  • In most experienced hands, the endoscope is advanced to the junction of where the colon and small bowel join up (caecum) in under 5-10 minutes in 99% of cases.

  • Suspicious lesions may be cauterized, treated with laser light or cut with an electric snare for purposes of biopsy or complete removal - polypectomy. Medication can be injected, e.g. to control bleeding lesions. On an average, the procedure takes 20-30 minutes, depending on the indications and findings.

What will happen after the procedure?
  • Patient will be taken to the recovery room where the blood pressure and heart rate is monitored while they rest and a slow drip of IV fluids given.

  • Patient will generally wake up within ½ hour not realizing that the procedure has already been done and may experience mild disorientation upon waking which will soon pass.

  • Patient may feel slightly bloated which is normal and will be encouraged to pass flatus, this distention will disappear in a few hours.

  • Patient will be able to resume normal regular diet, medications and may also be able to return to work on the same day after a few hours of rest in most cases.

What are the risks involved?
  • This procedure has a low (0.2%) risk of serious complications.

  • Potential serious complications include a tear or hole in the lining of the colon called a perforation. Rates of perforations are in the order of less than 1 in 2000 colonoscopies.

  • Bleeding complications may be treated immediately during the procedure. Delayed bleeding may also occur at the site of polyp removal up to a week after the procedure and a repeat procedure can then be performed to treat the bleeding site.

  • Less serious complications would include cardiopulmonary complications such as temporary drop in blood pressure and oxygen saturation.

  • In rare cases, more serious cardiopulmonary events such as a heart attack or stroke may occur but these often occur in critically ill patients with multiple risk factors.

Images

Normal terminal ileum

Normal ileo-caecal junction

Normal Caecum

Normal Transverse colon

Normal Sigmoid colon

Normal Rectum

A large polyp in caecum (Lipoma)

Polyp in caecum (NBI)(Lipoma)

Colon cancer (Splenic flexure)

Large ulcerated area

Heamoclip application on ulcer bleed in ileum

Colonic Angiodysplastic lesion

Colonic Angiodysplastic lesion

Ulcerative Proctitis

SRUS (White Light)

SRUS (NBI)

Diverticular disease of sigmoid colon

Non specific colitis

Pseudopolyp in ulcerative colitis (NBI)

Rectal cancer

Colonic polyp with stalk

Polypectomy performed

Ulcerative colitis

EUS (Endoscopic Ultrasound)

What is Endoscopic Ultrasound (EUS)?

Endoscopic Ultrasound (EUS) is an imaging modality that combines the endoscopic view and the ultrasound picture. Endoscopy refers to the procedure of inserting a long flexible tube via the mouth or the rectum to visualize the digestive tract whereas ultrasound uses high-frequency sound waves to produce images of the organs and structures inside the body such as ovaries, uterus, liver, gallbladder, pancreas, aorta, etc. In EUS a small ultrasound transducer is installed on the tip of the endoscope. Placing the transducer on the tip of an endoscope allows the transducer to get close to the organs inside the body. Because of the proximity of the EUS transducer to the organ(s) of interest, the images obtained are frequently more accurate and more detailed than the ones obtained by traditional ultrasound. The EUS also can obtain information about the layers of the intestinal wall as well as adjacent areas such as lymph nodes and the blood vessels.

Two main types of EUS transducers are available - One is a radial imaging device that produces a 360-degree, cross-sectional image (also called a "slice"). The other is a curved linear array instrument that uses Doppler and pulse Doppler ultrasound that can guide a fine-needle aspiration (biopsy) of lymph nodes and tumors. Physicians choose the transducer that will produce the image they need to assess a patient's problem

How does Endoscopic Ultrasound (EUS) work?
  • The endoscope is passed through the mouth and advanced to through the esophagus to the suspicious area. From various positions between the esophagus and duodenum organs within and outside the gastrointestinal tract can be imaged to see if they are abnormal and they can be biopsied by a process called "fine needle aspiration." Organs such as the liver, pancreas and adrenal glands are easily biopsied as are any abnormal lymph nodes. In addition, the gastrointestinal wall itself can be imaged to see if it is abnormally thick suggesting inflammation or malignancy.

  • The quality of the image produced is directly proportional to the frequency used. Therefore a high frequency produces a better image. However, high frequency ultrasound does not penetrate as well as lower frequency ultrasound so that the examination of the nearby organs is not possible. The procedure is performed by an endoscopist who has had extensive advanced training.

  • EUS is an operator dependant endoscopic imaging modality and therefore the accuracy varies from center to center. It is a cost-effective, non-surgical assessment for certain diseases and as it is a technically demanding and complex procedure, an experienced endoscopist should perform the EUS for accurate results.

In what way is Endoscopic Ultrasound (EUS) preferred to other imaging modalities?
  • This method is superior in staging and diagnosing of gastrointestinal cancer and benign diseases in esophagus, stomach, pancreas, and related organs. EUS have shown to be superior in assessment of the common bile duct in patients suspected for common bile duct stones.

  • It also allows for biopsying of any focal lesions found in the upper gastrointestinal tract. This is done by inserting a needle through the stomach lining into the target tissue to obtain samples by passing a special needle, under ultrasound guidance, into enlarged lymph nodes or suspicious tumors. The tissue or cells obtained by the needle can be examined by a pathologist under a microscope. The process of obtaining tissue with a thin needle is called Fine Needle Aspiration (FNA).

What are the reasons and advantages of an Endoscopic Ultrasound in Cancers?
  • To detect and stage gastrointestinal, lung, esophageal, gastric, rectal and pancreatic cancers. Staging of cancer is becoming an important use of EUS.

  • The prognosis of a cancer victim is related to the stage of the cancer at the time of cancer detection. For example, early stage colon cancer refers to cancer confined to the inner surface of the colon before it is spread to adjacent tissues or distant organs. Therefore early stage colon cancers can be completely resected with good chances for cure. However, if cancer is detected at later stages, the cancer tissues have already penetrated the colon wall and invaded neighboring organs and lymph nodes, or have spread to distant organs such as liver and lungs. Complete surgical excision becomes highly unlikely.

  • EUS can provide information regarding the depth of penetration of the cancer and spread of cancer to adjacent tissues and lymph nodes, information useful for staging.

What other diseases can be detected and diagnosed on Endoscopic Ultrasound?
  • Detect common bile duct stones. Stones in the bile tubes leading from the gallbladder to the intestine have traditionally been detected by an endoscopic retrograde cholangiogram (ERCP), an invasive test or and MRCP. EUS is much less invasive and can detect these stones with far more accuracy as compared to ERCP or MRCP.

  • Assess masses in the submucosal lining of the gastrointestinal tract

  • Diagnose diseases of the internal organs like the pancreas, for chronic pancreatitis or cysts of the pancreas.

  • Unexplained weight loss or persistent dyspepsia (periluminal TB lymphnodes).

How does one prepare for an Endoscopic Ultrasound (EUS)?
  • Do not eat or drink for at least 6 hours to keep your stomach empty.

  • Inform your doctor if you have any allergies, heart or respiratory problem.

    1. Are on anti diabetic on anti hypertensive drugs

    2. Are taking any medication for thinning the blood

    3. Any previous endoscopy or any other investigation

    4. Significant past history

  • You can have your anti diabetic and anti hypertensive drugs with sips of water on the day of procedure.

  • If there is a possibility of Fine Needle Aspiration (FNA), the doctor will want to check your blood for proper clotting. It is important to inform your doctor of any family history of bleeding problems or if you are taking medications for thinning the blood.

What will it be like when you arrive at Endoscopy Asia for an Endoscopic Ultrasound (EUS)?
  • When you come for a Endoscopic Ultrasound (EUS), you will be required to come with all your previous investigations and files relating to your current problem

  • Doctor will give a detailed consultation regarding the probable cause of the problem and recommend the required investigation/endoscopy and that you would be made aware of the treatment options and possible risks involved and a given consent form to be signed prior to the endoscopy.

  • Patient will be taken to the procedure room and made comfortable. The nursing staff will prepare the patient with the necessary IV cannula which will be used for medications required during the procedure and post procedure for slow IV fluids and then spray some anaesthetic agent onto the back of the throat to make it numb prior to the procedure.

  • Patient will be asked to bite on a plastic mouth guard to protect the teeth as well as the endoscope from being bitten during the procedure. The endoscope will not interfere with your breathing.

  • The Anaesthetist / Doctor / Nurse will administer a light sedative intravenously through the IV line such as midazolam, fentanyl or propofol in order to have a smooth, comfortable and a painless EUS experience for the patient.

What will happen after the procedure?
  • Patient will be taken to the recovery room where the blood pressure and heart rate is monitored while they rest and a slow drip of IV fluids given.

  • Patient will generally wake up within ½ hour not realizing that the procedure has already been done and may experience mild disorientation upon waking which will soon pass.

  • Patient may feel slightly bloated which is normal and will be encouraged to pass flatus, this distention will disappear in a few hours.

  • Patient will be able to resume normal regular diet, medications and may also be able to return to work on the same day after a few hours of rest in most cases.

Risks
  • This procedure has a low (0.2%) risk of serious complications.

  • Potential serious complications include a tear or hole in the lining of the digestive tract called a perforation. Rates of perforations are on the order of less than 1 in 2000 upper endoscopy.

  • Bleeding complications are extremely rare after an EUS guided FNA (biopsy) of the pancreatic mass lesion or any other periluminal lesion.

  • Complications related to therapeutic EUS are also rare which includes spontaneous infection of pseudocyst during the drainage of pancreatic pseudocyst or FNA of cystic neoplasm of pancreas.

  • Sometimes patient may experience diarrhea which can be treated with medicines after EUS guided FNI for pain relief procedures such as EUS-CPN (EUS guided Coeliac Plexus Neurolysis)

  • Less serious complications would include cardiopulmonary complications such as temporary drop in blood pressure and oxygen saturation. These developments often are the result of overmedication and easily reversed. In rare cases, more serious cardiopulmonary events such as a heart attack or stroke may occur but these often occur in critically ill patients with multiple risk factors.

Images

Gall bladder with stones

CBD & MPD seen

Pancreas-Body with MPD

Mediastinal nodes

Cancer Esophagus Staging

Pancreatic head mass

Normal wall layers of Stomach

Cancer of Pancreas Head

Calcific Chronic Pancreatitis

Cholangio-Carcinoma

EUS-FNA Mediastinal Mass

EUS-FNA Perigastric Node

EUS-FNA Pancreatic Head Mass

Large Perigastric Node

Large round worm in CBD on EUS

Reap The Benefits Of Endoscopic Ultrasound At Endoscopy Asia

ERCP (Endoscopic Ultrasound)

What is ERCP?
  • Endoscopic refers to the use of an instrument called an endoscope - a thin, flexible tube with a tiny video camera and light on the end.

  • Retrograde refers to the direction in which the endoscope is used to inject a liquid enabling X-rays to be taken of the parts of the GI tract called the bile duct system and pancreas.

  • The process of taking these X-rays is known as Cholangiopancreatography. Cholangio refers to the bile duct system, pancrea to the pancreas.

  • ERCP is an endoscopic procedure which is a diagnostic as well as a therapeutic procedure to examine the duodenum (the first portion of the small intestine), the ampulla of Vater (a small nipple-like structure with openings leading to the bile ducts and the pancreatic duct), the bile ducts, the gallbladder and the pancreatic duct.

How is ERCP performed?

The procedure is performed by using a long, flexible, viewing instrument (a duodenoscope) about the diameter of a pen. The duodenoscope is flexible and can be directed and moved around the many bends of the stomach and intestine.  The duodenoscope is inserted through the mouth, to the back of the throat, down the food pipe, through the stomach and into the first portion of the small intestine (duodenum). Once the ampulla of Vater is identified, a small plastic catheter (cannula) is passed through an open channel of the duodenoscope into the ampulla of Vater, and into the bile ducts and/or the pancreatic duct. Contrast material (dye) is then injected and x-rays are taken of the bile ducts and the pancreatic duct. The open channel also allows other instruments to be passed through it in order to perform biopsies, to remove bile duct stones and to insert plastic or metal stents to relieve obstruction of bile ducts caused by cancer or scarring, and to perform incision by using electrocautery (electric heat).

What are the functions of the pancreas and the bile duct system?

Bile is a substance made by the liver that is important in the digestion and absorption of fats. Bile is carried from the liver by a system of tubes known as bile ducts. One of these, the cystic duct, connects the gallbladder to the main bile duct. The gallbladder stores the bile between meals and empties back into the bile duct when food is consumed. The common bile duct then empties into a part of the small intestine called the duodenum. The common bile duct enters the duodenum through a nipple-like structure called the papilla. Joining the common bile duct to pass through the papilla is the main duct from the pancreas. This pathway allows digestive juices from the pancreas to mix with food in the intestine. Problems that affect the pancreas and bile duct system can, in many cases, be diagnosed and corrected with ERCP.

What are the reasons for an ERCP?

The liver, bile ducts, gallbladder, pancreas and the ampulla of Vater can be involved in numerous diseases, causing myriad of symptoms. ERCP is used in diagnosing and treating the following conditions:

  • Gallstones in the bile duct

  • Blockage of the bile duct by stones, cancer, stricture or compression from adjacent organs

  • Jaundice (yellow coloring of the skin) due to obstruction of the bile duct secondary to stones or tumors of bile ducts, gall bladder and pancreas or ampulla of Vater, which will cause darkening of the urine and light colored stool.

  • Persistent or recurrent upper abdominal pain which cannot be diagnosed by other tests

  • Unexplained loss of appetite and weight loss

  • Confirming the diagnosis of cancer of the pancreas or the bile duct, so that surgery or other treatment can be tailored.

  • Similarly, blockage of the pancreatic ducts from stones, tumors, or stricture can also be evaluated or treated by ERCP, which is useful in assessing causes of acute or recurrent acute and chronic pancreatitis (inflammation of the pancreas).

How do I prepare for an ERCP?
  • An overnight fasting after midnight is required in order to have the stomach empty

  • Tell your doctor if you have any allergies, heart or respiratory problem

    1. Are on anti diabetic on anti hypertensive drugs

    2. Are taking any medication for thinning the blood

    3. Any previous endoscopy or any other investigation

    4. Significant past history

  • You can have your anti diabetic and anti hypertensive drugs with sips of water on the day of procedure

  • If there is a possibility of endoscopic sphincterotomy, the doctor will want to check your blood for proper clotting. It is important to inform the doctor of any family history of bleeding problems or if you are taking medications for thinning the blood.

What will it be like when you arrive at Endoscopy Asia for an ERCP?

When you come for an ERCP, you will be required to come with all your previous investigations and files relating to your current problem

Doctor will give a detailed consultation regarding the probable cause of the problem and that you would be made aware of the possible risks involved and a given consent form to be signed prior to the endoscopy.

Patient will be taken to the procedure room and made comfortable. The nursing staff will prepare the patient with the necessary IV cannula which will be used for medications required during the procedure and post procedure for slow IV fluids and then spray some anaesthetic agent onto the back of the throat to make it numb prior to the procedure.

Patient will be asked to bite on a plastic mouth guard to protect the teeth as well as the endoscope from being bitten during the procedure. The endoscope will not interfere with your breathing.

The Anaesthetist / Doctor / Nurse will administer a light sedative intravenously through the IV line such as midazolam, fentanyl or propofol in order to have a smooth, comfortable and a painless ERCP experience for the patient. General anaesthesia is rarely used.

The patient is made to lay down on the left side of the x-ray table. The endoscope is passed through the mouth into the duodenum. It does not interfere with the breathing.

When the patient is in deep sedation, he/she can still follow instructions to change the position on the x-rays table. Once the instrument has been advanced into the stomach, there is minimal discomfort. The procedure can last any where from fifteen minutes to one hour, depending on the skill of the physician and the anatomy or abnormalities in that area.

In the duodenum, the instrument is positioned near the papilla, the point at which the main ducts empty into the intestine. A small tube known as a cannula is threaded down through the endoscope and can be directed into either the pancreatic or common bile duct. The cannula allows a special liquid contrast material, a dye, to be injected backwards - that is, retrograde - through the ducts.

X-ray equipment is then used to examine and take pictures of the dye outlining the ducts. In this way, widening, narrowing, or blockage of the ducts can be pinpointed.

Some of the problems that may be identified during ERCP can also be treated through the endoscope. For example, if a stone is blocking the pancreatic or common bile duct, it is usually possible to remove it.

First, the opening in the papilla is cut open and enlarged. Then, a special device can be inserted to retrieve the stones. Narrowing or obstruction can also have other causes, such as scarring or tumors. In some cases, a plastic or metal tube (called a stent), can be inserted to provide an opening. If necessary, a tissue sample or biopsy can be obtained, or a narrow area dilated.

What will happen after the ERCP procedure?

Patient will be taken to the recovery room where the blood pressure and heart rate is monitored while they rest and a slow drip of IV fluids given.

Patient will generally wake up within ½ hour not realizing that the procedure has already been done and may experience mild disorientation upon waking which will soon pass.

You may require overnight admission for observation or sent back to your primary doctor, nursing home, hospital or home.

Patient may feel slightly bloated which is normal and will be encouraged to pass flatus, this distention will disappear in a few hours.

You may resume your regular diet and medications only after proper examination by your doctor.

What are the advantages of ERCP?

Thanks to ERCP, these kinds of procedures may help you to avoid surgery. ERCP is a highly specialized procedure which requires vast experience and high levels of skill. The procedure is quite safe and is associated with a very low risk when it is performed by an experienced endoscopist. The success rate in performing this procedure varies from 70% to 95% depending on the experience of the endoscopic surgeon. However, at Endoscopy Asia our success rate for ERCP is 98% to 99%.

In summary, ERCP is a rather simple outpatient procedure that is performed with the patient sedated. The procedure provides significant information upon which specific treatment can be tailored. In certain cases, therapy can be performed at the same time through the duodenoscope, so that traditional open surgeries can be avoided. ERCP is now mainly used as a therapeutic procedure of choice in most patients for identifying and removing gallstones in the bile ducts and pancreatic duct. It is also important to drain obstructed ducts with the use of plastic or metal stents in cases of obstruction of bile duct secondary to cancers of bile duct, gall bladder, pancreas, duodenum or ampulla of vater. ERCP is also very useful in treatment of acute, recurrent and chronic pancreatitis which can avoid surgery in some patients.

What are the risks of ERCP?

Complications can occur in approximately one to five percent depending on the skill of the endoscopic surgeon and the underlying disorder. The most common complication is pancreatitis which is due to irritation of the pancreas and can occur even in the hands of very experienced endoscopists. This "injection" pancreatitis is usually treated in the hospital for one to two days. Another possible complication is infection. Other serious risks including perforation of the bowel, drug reactions, bleeding, depressed breathing, irregular heart beat or heart attack are extremely rare. In case of complication, patient needs to be hospitalized and surgery is rarely required. However, at Endoscopy Asia our analysis has shown that the overall complication rate of ERCP is less than 1%.

Images

Impacted CBD stone in the Ampulla

Stones delivered after sphincterotomy

Biliary sphincterotomy performed

Pancreatic Balloon Sphincteroplasty

ERCP- Pancreatogram shows stones in MPD

Pancreatic stone removal.

Plastic Biliary stent

Metal Biliary stent

Bulging Ampulla - Tumor

EUS guided Cystogastrostomy for Pancreatic Pseudocyst

Balloon dilatation of the tract

Double pigtail stent placed in the pseudocyst

Fluoroscopy image of scope and stent

Cholangiogram of Cancer Gall Bladder

CBD stone on cholangiogram

Dark bile flow

Frank pus with stone

Single Balloon

What is Single Balloon Enteroscopy?

Single-balloon enteroscopy, also known as push-and-pull enteroscopy, is an endoscopic technique for visualization of the entire length of the small intestine in real time which was the only blind area for the endoscopist earlier.

What are the reasons for the procedure?

Single-balloon enteroscopy has found a niche application in the following settings:

  • Bleeding from the gastrointestinal tract of obscure cause

  • Iron deficiency anemia with normal colonoscopy and gastroscopy

  • Visualization and therapeutic intervention on abnormalities seen on traditional small bowel imaging

  • ERCP in post-surgical patients with long afferent limbs

How do I prepare for a Single Balloon Enteroscopy?
  • Do not eat or drink for at least 6 hours to keep your stomach empty.

  • Tell your doctor if you have any allergies , heart or respiratory problem

    1. Are on anti diabetic on anti hypertensive drugs

    2. Are taking any medication for thinning the blood

    3. Any previous endoscopy or any other investigation

    4. Significant past history

  • You can have your anti diabetic and anti hypertensive drugs with sips of water on the day of procedure.

What will it be like when you arrive at Endoscopy Asia for a Single Balloon Enteroscopy?
  • When you come for a Single Balloon Enteroscope, you will be required to come with all your previous investigations and files relating to your current problem

  • Doctor will give a detailed consultation regarding the probable cause of the problem and that you would be made aware of the possible risks involved and a given consent form to be signed prior to the procedure.

  • Patient will be taken to the procedure room and made comfortable. The nursing staff will prepare the patient with the necessary IV cannula which will be used for medications required during the procedure and post procedure for slow IV fluids and then spray some anaesthetic agent onto the back of the throat to make it numb prior to the procedure.

  • Patient will be asked to bite on a plastic mouth guard to protect the teeth as well as the endoscope from being bitten during the procedure. The endoscope will not interfere with your breathing.

  • The Anaesthetist will administer a light sedative intravenously through the IV line such as midazolam, fentanyl or propofol in order to have a smooth, comfortable and a painless Single Balloon Enteroscopy experience for the patient.

  • The patient is made to lay down on the left side of the x-ray table. The endoscope is passed through the mouth into the duodenum. It does not interfere with the breathing. The entire procedure is done under X-ray.

  • The technique involves the use of a balloon at the end of a special enteroscope camera and an overtube, which is a tube that fits over the endoscope, and which is also fitted with a balloon. The procedure is usually done under general anesthesia, but may be done with the use of conscious sedation. The enteroscope and overtube are inserted through the mouth and passed in a conventional fashion (just like the  Gastroscopy) into the small bowel. Following this, the endoscope is advanced a small distance in front of the overtube and the balloon at the end is inflated. Using the assistance of friction at the interface of the enteroscope and intestinal wall, the small bowel is accordion back to the overtube. The overtube balloon is then deployed, and the enteroscope balloon is deflated. The process is then continued until the entire small bowel is visualized.

  • The Single-Balloon Enteroscope can also be passed in retrograde fashion, through the colon and into the ileum to visualize the end of the small bowel. This procedure is rather long and can take anywhere from 2 to 4 hours.

What will happen after the procedure?
  • Patient will be taken to the recovery room where the blood pressure and heart rate is monitored while they rest and a slow drip of IV fluids given.

  • Patient will generally wake up within ½ hour not realizing that the procedure has already been done and may experience mild disorientation upon waking which will soon pass.

  • You may or may not require admission for overnight observation at a nursing home or hospital depending on your clinical recovery from the procedure.

  • Patient may feel slightly bloated which is normal and will be encouraged to pass flatus. This distention will disappear in a few hours.

  • You may resume your regular diet and medications only after proper examination by your doctor.

Risks
  • This procedure has alow (0.2%) risk of serious complications.

  • Potential serious complications include a tear or hole in the lining of the digestive tract called a perforation. Rates of perforations are on the order of less than 1 in 2000 upper endoscopy.

  • Bleeding complications may be treated immediately during the procedure. Delayed bleeding may also occur at the site of polyp removal up to a week after the procedure and a repeat procedure can then be performed to treat the bleeding site.

  • Less serious complications would include cardiopulmonary complications such as temporary drop in blood pressure and oxygen saturation. In rare cases, more serious cardiopulmonary events such as a heart attack or stroke may occur but these often occur in critically ill patients with multiple risk factors.

What are the advantages?

Single Balloon Enteroscopy offers a number of advantages to other small bowel image techniques, including barium imaging, wireless capsule endoscopy and push enteroscopy:

  • it allows for visualization of the entire small bowel to the terminal ileum

  • it allows therapeutic application

  • it allows for the sampling or biopsying of small bowel mucosa, for the resection of polyps of the small bowel, and in the placement of stents or dilatation of strictures of the small bowel.

  • it allows for access to the ampulla of Vater in patients with long afferent limbs after Billroth II Gastrectomy.

What are the disadvantages?

The key disadvantage of single-balloon enteroscopy is the time required to visualize the small bowel, this can exceed three hours, and may require that patients be admitted to hospital for the procedure. There has also been case reports of acute pancreatitis and intestinal necrosis and perforation associated with the technique.

Images

Proximal jejunum

Jejuno-Ileal junction

Crohns disease in Proximal Ileum

Crohns ulcer seen on NBI

Crohns disease mid ileum

Biopsy from Crohns ulcer mid ileum

Scope seen in proximal ileum on Fluoroscopy

Angiomatous lesion seen in the distal jejunum

Hyperemia seen in proximal jejunum

NBI view of Proximal Ileum

superficial ulceration in the proximal ileum

Know More About OGD scopy, Colonoscopy, EUS , ERCP and other Endoscopy Procedures | Endoscopy Asia

Frequently Asked Questions

When is Endoscopy required?

Some of these symptoms like severe upper or lower abdominal pains, ulcers, gastritis, reflux, blood in vomitus, blood in stools etc...! requires an Endoscopy to be done in order to evaluate the gastro intestinal tract.

Is Endosocopy done under anesthesia?

It is done under a light sedation through an IV line and the patient usually wakes up within 30 min of the procedure. General Anesthesia is only given in special circumstances.

Any preparations required prior to an Endoscopy?

One has to be fasting 6-8 hrs prior or may be given a laxative to clear the bowels if necessary according to the doctor`s orders.

Is Endoscopy painful?

No, Endoscopy is not painful.

Is Endoscopy expensive?

Endoscopy is cost effective as compared to an open surgery if any interventional procedures are required.

Is Endsocopy time consuming?

It depends on the procedure that is required but by and large most procedures take an average of 30 minutes.

Is Endoscopy safe in Elderly and Children?

It is absolutely safe in healthy elderly patients and children.

Does Endoscopy lead to complications?

No, the complications rate at Endoscopy Asia is less then 1%.

Can Endoscopy be done repeatedly?

Yes, it can only when it is indicated.

Will I feel pain in the throat after the Endoscopy?

No pain as such but sometimes some patients have a little discomfort for a while.

Can Endoscopic biopsy lead to the spread of cancer?

No, it is a misconception.

Can I return to work after an Endoscopy?

In most cases, Endoscopy is an out-patient procedure so patients can normally return to work except after an advanced therapeutic procedure where the patient may require an overnight observation.

Can I come alone for the procedure?

It is advisable to bring a caregiver/relative if you are going to have an endoscopy procedure.

When a biopsy is taken, how long does it take to get the results?

It depends, if it is a biopsy for H-Pylori Infection the result is immediate and if it is a regular histopathology biopsy it normally takes 3 to 4 working days.

Will I be able to use my Mediclaim for an Endsocopy?

In most mediclaims you require an overnight stay in the hospital. So yes, it can be possible as an overnight stay can be arranged at the hospital.

Facilities:

Click Here For an Appointment

Visa Assistance
We provide assistance in arranging Medical Visa, Visa registration/ extension to International Patients.
Accommodation Facility
There is a wide price range of hotels, guest houses, service apartments available in vicinity of the hospital. We provide assistance in booking of a good & economically suitable accommodation depending on the patient\`s choice.
Local Mobile Number
To help save communication costs with family members at home we provide assistance to avail an Indian phone number.
Free Consultation for your assisting family member
We offer free consultations and check up the attendants of all International patients.
Complimentary Airport pickup and drop
We offer complimentary airport pick up & drop for International Patients.
Dedicated Relationship Manager
To avoid any problem for International Patients, Relationship Managers are appointed at every point of the treatment process from their arrival to Airport till their discharge.
Travel Desk
Endoscopy Asia has a dedicated Travel Desk which takes care of services like Vehicle arrangement for Local Travel, Assistance in arrangement of Tickets, Assistance in fulfilling the formalities before travel, resolving all travel enquiries of International Patient travelling back to their country.
Kindly see to here the list of the most desirable tourist destinations in Mumbai.

* Click the Images for Details


Bhaucha Dhakka Dockyard

The Gateway of India

The Taj Mahal Palace and Towers

The Prince of Whales Museum

Chhatrapati Shivaji Terminus

Crawford Market

Elephanta Caves

Mount Mary Church, Bandra

Girgaum Chowpatty

Juhu Beach

Haji Ali

Siddhivinayak Temple, Prabha Devi

St. Michael`s Church

Dhobi Ghat - Mahalaxmi

Sanjay Gandhi National Park

Bandra-Worli Sea Link

Global Vipassana Pagoda

Marine Drive

Antilia


Kindly see to here the list of the most desirable tourist destinations in India.


TAJ MAHAL - Agra

JAMA MASJID - Delhi

Lake Palace - Udaipur

The Harmandir Sahib - The Golden Temple

Jodhpur City and Fort

Lakshadweep Islands

Hogenakkal Falls

Ghats in Varanasi

Nanda Devi Mountains

Backwaters of kerala