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GASTROENTEROLOGY

Overview

AMALA IMS became one of the frontrunners in Gastroenterology, with the setting up of the department in April 1996.  The department was upgraded to Amala Gastro Centre in 2019.

Presently the department caters to a huge number of patients on a daily basis, catering to their gastric problems, providing complete healing solutions. It runs regular OPD and endoscopy services, including 24 hr emergency services, to address the same. The department has the most modern HD video upper GI scopes and colonoscopes, with Narrow Band Imaging (Olympus Exera II CV – 180 series), ERCP, EUS and C-Arm Facilities. Further, interventional radiology procedures like Angio, Embolization, TACE, Microwave Ablation and PTBD are performed regularly. More than 600 advanced endoscopic procedures are being performed every year.

Upper GI scopy includes routine diagnostic work, banding of oesophageal varices, sclerotherapy of oesophageal and gastric varices, dilatation of oesophageal strictures, and foreign body removal. Stenting of malignant oesophageal strictures, Polypectomy, Endoscopic nasogastric and nasojejunal tube placement and haemorrhoidal banding are also undertaken. Selectron therapy of oesophageal malignacies are regularly done. Lower GI scopies include colonoscopy and flexible sigmoidoscopy.

Amala Gastro Centre also has one of the strongest surgical gastro teams, with advanced Laparoscopic and complex surgeries, including liver surgeries, being performed regularly. The team consists of 3 Medical Gastroenterologists, 2 surgical gastroenterologists, an interventional radiologist and a dedicated Gastro-pathology team.

The department also is involved in Hepatology. Patients with acute Hepatitis, as well as chronic liver diseases, attend the gastro OPD regularly, and undergo in-patient treatment, if required.

The department offers Diploma in Endoscopic Technology since July 2012, with a student intake of four per year. In 2019, the department started offering D.N.B. Course in Gastroenterology, with an intake of two residents.

Facilities

  • OPD s with all modern facilities and spacious waiting area
  • 3 ultra modern state of the art endoscopic suites with anaesthesia capability
  • Day care procedure room
  • VIP lounge
  • Comfortable Endoscopic preparation area
  • Dedicated Gastro ICU
  • Dedicated ward - room complex for Gastro patients
  • Speciality clinics for IBD and NASH
  • Latest Endoscopes ( Olympus 190/ 180/ 170; Fujinon 600 series, paediatric colonoscope, therapeutic Endoscope, ERCP scope Endoscopic ultrasound - Olympus)
  • Spiral Enteroscope
  • Erbe 200D cautery
  • Ziehms C arm 8000
  • GE ultrasound machine

Services

This is a safe and most accurateprocedure uses an endoscope( flexible camera device) to examine the interior of upper GI organs like Esophagus ( food pipe)Stomach & Small bowel . Unlike many other medical imaging techniques, endoscopes are inserted directly into the organand perform biopsy and removal of suspicious tissues and accidentally swallowed objects with precision.Procedure can be done comfortable under conscious sedation or local anesthesia

This also is endoscopic examination of the large bowel and the distal part of the small bowel with a high definition camera flexible tube passed through the anus. It can provide a visual diagnosis (e.g., ulceration, polyps) and grants the opportunity for biopsy or removal of suspected colorectal cancer lesions.

Latest and advanced technique of completely visualizing the very long small bowel with assiatance of specialized motorized spirally moving endoscope. It can also do dedicated therapy for internal bleeding , take biopsies and remove tumours and accidentally swallowed objects etc

Endoscopic retrograde cholangiopancreatography (ERCP) is an advanced procedure or surgery done with specialized Side viewing endoscope with assistance of X-Ray mainly for diseases of pancreas , bile ducts, Tumors and stones arising from these organs

Endoscopic ultrasound (EUS) is a highly advanced imaging echoendoscope to assess diseases of the digestive (gastrointestinal) tract and other nearby organs and tissues. Endoscopic ultrasound combines the use of a thin, flexible tube (endoscope) inserted into the gastrointestinal tract and a device that uses sound waves to create images (ultrasound).Its proves the best images for early cancer detection especially in pancreato biliary diseases .EUS can also be used for guided therapies like vascular coiling, and surgery like Cystogastrostomy and internal abscess drainage

The hydrogen breath test is a simple and noninvasive way to diagnose common gastrointestinal conditions, including severe bloating , lactose intolerance and SIBO (small intestine bacterial overgrowth). It does take some advance preparation to make sure results are accurate. The breath test evaluates your digestion of particular sugars by measuring the gas you exhale, usually hydrogen and methane

Supportive and palliative endoscopic procedure ,flexible self expanding metal alloy stent is placed in your esophagus (throat) to keep open a blocked or narrow area caused by cancers . The tube helps you swallow solids and liquids through the mouth and procedure is with surgery or scar.

procedure in which the hemorrhoid is tied off at its base with rubber bands, cutting off the blood flow to the hemorrhoid. This treatment is only for internal hemorrhoids. To do this procedure, a doctor inserts a viewing scope (anoscope) into the anus.

This treatment is recommended for fundal variceal bleedings, while glue or endovascular coils are inserted using EUS or endoscope in cases of life threatening GI bleeding

Approximating device clip is used to stop bleeding from vessel typically Duodenal ulcer in the upper GI tract

APC is a procedure that uses ionized gas to cause the blood to clot (coagulate) or to form scar tissue in the digestive tract. APC may be used in GI procedures to treat areas of bleeding or to address weight regain after gastric bypass

This is a Minimal access surgery PEG (percutaneous endoscopic gastrostomy) feeding tube insertion is the placed through the skin and the stomach wall using endoscopy . It goes directly into the stomach. PEG feeding tube insertion can done under conscious sedation or IV anesthesia

Cystogastrostomy is an endoscopic surgery performed to drain a pancreatic pseudocyst that develops after acute or chronic pancreatitis

A procedure that uses an endoscope to remove abnormal growths or tissue from the lining of the digestive tract without open surgery

A polypectomy is the surgical removal of a polyp.

Endoscopic method used in removal large GI bleeding polyps to prevent post polypectomy bleeding (particularly with large stalked polyps)

a flexible, metallic tube specially designed to hold open a part of your bowel that is either partially or totally blocked. This place under endoscopic and fluoroscopic support

The over-the-scope clip system. The OTSC system is a full-thickness closing device designed for flexible endoscopes, intended for the closure of the wound surface of target diseases including non-variceal GI bleeding, perforation, fistula, and anastomotic dehiscence

Inflatable balloon are deployed into stomach to reduce the stomach volume as way of treating severe obesity .These balloon are kept for 6 -12 month anad safely removable after achieving the weigh goals

We provide prescribed customized diets for Cirrhosis , Pancreatic diseases ,maldigestion ,IBD an similar GI issues with help of qualified nutritionist, They provide specialist evidence-based dietary advice and written resources to support patients to manage their condition, together with their medical treatment.

Liver biopsy is a procedure to remove a small piece of liver tissue, so it can be examined under a microscope for signs of damage or disease. Procedure can be done under local anesthesia and short stay at hospital .Your health care provider may recommend a liver biopsy if blood tests or imaging studies suggest you might have a liver problem

Gastrointestinal interventional radiology deals with the diagnosis and treatment of a range of gastrointestinal conditions using advanced fluoroscopy and Cath lab.

Severe Internal bleeding can be addressed without surgery using angiogram of possible area and bleeding site can be identified and corrected by blocking the culprit blood vessel

Minimally invasive method which uses electrical currents or electromagnetic waves (microwaves) to destroy cancer cells. Each technique uses image guidance usually CT or Ultrasound to directly target cancer cells and ensure that healthy tissues are not harmed.

Gastric varices ( Bleeding large vessels in the stomach are blocked angiographically with sclerosant , coil or plug in cases of severe bleeding using angiography and X ray .Coil-assisted retrograde transvenous obliteration (CARTO) is a modified balloon-occluded retrograde transvenous obliteration (BRTO) technique using coils instead of an indwelling balloon

Percutaneous Transhepatic Biliary Drainage (PTBD) is a medical procedure for treatment of a bile duct obstruction. The objective of the procedure is to locate the obstruction and/or to insert a temporary catheter/ stents to drain the bile through the skin under sedation .

a minimally-invasive, image-guided treatment for liver cancer. It helps shrink or eradicate tumors by targeting them and blocking their blood flow and delivering chemotherapy directly to the tumor.

Surgical Gastroenterology is a sub-speciality dealing with the management of diseases related to the human gastrointestinal tract involving the organs namely oesophagus, stomach, pancreas, liver, gall bladder and biliary tract, small and large intestine, rectum and anus.

Faculties

Dr. Robert P Panakkal

Professor & HOD

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Dr. Sojan George K

Associate Professor & Senior Consultant

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Dr. Anoob John K A

Assistant Professor & Senior consultant

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Dr. Byju Kundil

Senior Consultant Surgical Gastroenterologist

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Dr. Rajany Antony

Assistant Professor & Senior consultant

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Dr. Jijoe John

Interventional Radiologist

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Dr. Dominic Mathew

Assistant Professor

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Dr.edisal Raphael

Senior Resident

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CME

CME Details Date of Conduct
Name : EPIC - Gastro 2018
Theme/Subject : Expert opinion on Practical Issues in Clinicak Gastroentrology

2018

Publications

  • Text book chapter – Pathogenesis & management of acute diarrhea practical gastroenterology 2016 edition
  • H pylori infection in patients with liver cirrhosis-prevalence and association with portal hypertensive gastropathy annals of gastro 2014
  • Strongyloidiasis –a foreigner of adult cell lymphoma tropical gastroenterology 2014
  • Splenic abscess due to chronic meliodosis in a patient misdiagnose & CUTB Annals gastro 26(1),77,2013
  • Association of poor ora hygiene with SBP in cirrhotic with journal of orofacial research 79-81,2020
  • Hypocalamic crisis due to adult T cell leukemia-a rare case of –Annals of Gastro 2012
  • Bilirubin AST & platelet score –for differenced patients with CHB with acute flue of CHB Annals Gastro 2014
  • Strongyloidiasis a rare case for urinary infection in a alchoholic Indian journal of care reports 2020,250-251