Apollo Hospital

Prevention, diagnosis and treatment of diseases of the digestive tract, liver and pancreatico-biliary system in children and adults is the core objective of the Centres of Medical and Surgical Gastroenterology. The Centres offer state of art endoscopic procedures for gastrointestinal bleed, gastrointestinal cancers,foreign body removal etc. The gastrointestinal surgeons manage major gastrointestinal surgical problems of the intestines, pancreas and hepatobiliary tract including cancers, many of them through minimal access surgery. Apollo's comprehensive liver transplant care programme is well known for its highly successful Adult and Pediatric Liver Transplant programmes and cutting edge hepatoability procedures.

• First successful:

1. Pediatric liver transplant in India
2. Adult liver transplant in India
3. Cadaver liver transplant in India
4. Transplant in acute liver failure in India
5. Liver-kidney transplant in India

• Fastest growing Liver Transplant program in India with the biggest cadaver program for liver.
• Over 400 Liver Transplants performed with a success rate of 90%.
• Multi-organ Transplant Program at Apollo Hospitals New Delhi performed as many as 250 Liver and Kidney transplants in the year 2009.
• First of its kind Comprehensive Organ Transplant program being commenced at Apollo Hospitals Chennai.
• One of the country's busiest and rapidly growing Pediatric Liver transplant programs at Apollo Hospitals New Delhi

• Upper GI Endoscopy
• Capsule Endoscopy
• Enteroscopy
• Colonoscopy
• E R C P
• Endoscopic Ultrasonography

Upper GI endoscopy is a procedure that uses a flexible endoscope to visualize the upper GI tract. The upper GI tract includes the oesophagus, stomach, and duodenum - the first part of the small intestine.

• Treating diffused mucosal bleed with Argon plasma coagulation (APC)
• Dilation of narrowed food pipe (Balloon dilation of stricture and achalasia cardia)
• Metallic stenting of narrowed segments of food pipe or stomach
• Removal of polyps (polypectomy)
• Creating alternative pathway for feeding directly to stomach (PEG) or small intestine (PEG-J)
• Draining fluid collections though stomach (Cystogastrostomy) in patients with pancreatitis

1. How is upper GI endoscopy performed?

During the procedure, patients lie on their back or side on an examination table. An endoscope is carefully fed down the oesophagus and into the stomach and duodenum. A small camera mounted on the endoscope transmits a video image to a video monitor, allowing close examination of the intestinal lining. Air is pumped through the endoscope to inflate the stomach and duodenum, making them easier to see. Special tools that slide through the endoscope allow the doctor to perform biopsies, stop bleeding, and remove abnormal growths.

2. What problems can upper GI endoscopy detect?

Upper GI endoscopy can be used to determine the cause of

• Abdominal pain
• Nausea
• Nomiting
• Swallowing difficulties
• Gastric reflux
• Unexplained weight loss
• Anaemia
• Bleeding in the upper GI tract
It is used for both diagnostic and therapeutic procedures.

Diagnostic upper GI endoscopy is done to detect:

• Ulcers
• Abnormal growths
• Obstruction
• Inflammation
• Hiatal hernia
- source of bleeding
- tissue samples (biopsy) are also taken during endoscopy and sent for pathological examination to confirm the diagnosis.

The following therapeutic (treatment) procedures are also performed through upper GI endoscopy:

• Foreign body removal
• Treat bleeding ulcers by
   - Injection of medication (injection therapy)
   - Application of heat (coagulation) or
   - Application of clips (hemoclips) to the bleeding vessel
• Treat bleeding varices (engorged veins in liver disease) by applying plastic rings (EVL)
• Glue injection for gastric varix

Colonoscopy is a procedure used to see inside the colon and rectum.

1. What problems can colonoscopy detect?

Colonoscopy is a procedure used to see inside the colon and rectum.

Colonoscopy can help doctors diagnose the reasons for

• Unexplained changes in bowel habits
• Abdominal pain
• Bleeding from the anus
• Unexplained weight loss

Colonoscopy can also detect inflamed tissue, ulcers, 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. The doctor removes polyps and takes biopsy tissue using tiny tools passed through the scope. If bleeding occurs, the doctor can usually stop it with an electrical probe or special medications passed through the scope. Tissue removal and the treatments to stop bleeding are usually painless.

2. Colonoscopy can be used to:

• Remove polyps (polypectomy)
• Dilate narrowed segments (stricture dilation) of large intestine and place metallic stents across them (colonic stenting)
• Banding for haemorrhoids (piles banding)

3. How is colonoscopy performed?

During colonoscopy, patients lie on their left side on an examination table. The doctor inserts a long, flexible, lighted tube called a colonoscope, into the anus and slowly guides it through the rectum and into the colon. The scope inflates the large intestine with carbon dioxide gas to give the doctor a better view. A small camera mounted on the scope transmits a video image from inside the large intestine to a computer screen, allowing the doctor to carefully examine the intestinal lining. The doctor may ask the patient to move periodically so the scope can be adjusted for better viewing.

Once the scope has reached the opening to the small intestine, it is slowly withdrawn and the lining of the large intestine is carefully examined again. Bleeding and puncture of the large intestine are possible but they are uncommon complications during colonoscopy.

Dr.Ravi Shankar Bhat

MBBS, MS, DNB, FRCS, MCh

Senior Consultant, Department of Surgical Gastroenterology

Dr. Ravishankar Bhat, a renowned and respected name in the field of Surgical Gastroenterology, is a Senior Consultant in the department of Gastroenterology at Apollo Hospitals, Bangalore. He has carved a niche of his own, by conducting 329 Gastrectomy in the past 11 years. He is quite adept at performing Surgical Gastroenterology, Liver Transplant, Bariatric Surgeries and Minimal Invasive surgeries.