Gastroenterology and Hepatology is a superspeciality that involves management of patients suffering from disorders of digestive system and liver. These patients may be suffering from simple problems like indigestion or dyspepsia, constipation, pain in the abdomen, jaundice, diarrhoea or difficult problems like blood in the vomiting or stools, liver cirrhosis, swelling abdomen, bile duct stones, cancers of gall bladder, pancreas, food pipe, stomach or intestine.

The science in gastroenterology has advanced to a stage where not only there is application of clinical sense but the application of various endoscopic diagnostic and therapeutic procedures not only the diagnoses the problem but also helps to treat these through the endoscope. Advanced & Chronic liver disease, which had no treatment in the past, can now be treated effectively using modern medicines and the facility of liver transplant is changing the scenario in patients who were otherwise destined to die. Patients with advanced GI cancers be effectively managed by procedures like stenting & chemotherapy.

A good department these days boasts not only of good clinicians but also of the modern technologies in form of sophisticated endoscopes and accessories alongwith other investigational instruments and facilities of organ transplantation. The Department of Gastroenterology and Hepatology at Sir Ganga Ram Hospital is one of such & is recognised both nationally and internationally for its expertise and has established itself as a tertiary referral center covering most of North India. There is not a national conference in the field where one or the other consultant is not on the faculty.

The department is training not only its students who are pursuing Diplomate in National Board course (DNB) but also fellows from abroad. A number of observers from all over India come to observe and learn procedures. The department has all the possible instruments comparable to any advanced international center. The departmental mission is to provide an exceptionally high level of clinical care and emergency services to the patients.

The department provides outdoor services daily (except sunday). These services include both General and Private OPDs where the patients are attended to. General OPDs are run daily from 9:00 to 10:30 AM including two additional sub-specialty clinics namely Liver Clinic & Pancreatobilliary Clinic. All consultants run their private OPDs daily. The department has 50-60 patients admitted at any given time and these are taken care of by our residents and consultants. The department has its own high dependency unit (HDU), which provides critical care to relatively sicker patients. The department caters to emergencies by attending to patients presenting with various GI problems and liver disorders. There is round the clock availability of resident and consultants to treat these patients. The department is ably supported by the ICU and GI surgery.

The department carries out a number of procedures, which are both diagnostic as well as therapeutic in nature. It is one of the very few departments of GI & Hepatology to have facility of Oesophageal pH, endoscopic ultrasound (EUS). Argon Plasma Coagulation, GI manometry, Hepatic venous pressure measurements, Transjugular liver biopsy, MARS & Liver transplantation, besides the routine upper and lower GI procedures. The department is a referral centre for advanced therapeutic biliary & pancreatic procedures. Failed & difficult cases are usually referred here. We have recently acquired Double balloon Enteroscopy; which make us one of 3 centres in India to have this scope. High definition endoscopy is being added shortly.

• UGI Endoscopy: Is used for diagnosis of diseases of food pipe, stomach & duodenum like; reflux, ulcers & cancers.

• Endoscopic Sclerotherapy: Injection of sclerosant in bleeding varices (veins in cirrhosis) and ulcers.

• Endoscopic Variceal ligation (Banding): For ligating the varices

• Dilatation of Strictures: Dilating narrowed passages.

• Achalasia Dilatation

• APC: Argon Plasma Coagulation of bleeding lesions.

• Foreign Body Removal: It involves taking out foreign bodies ingested by using endoscope and accessories.

• Endoscopic / Fluroscopic Placement of Nasojejunal Tube: To maintain the nutrition in sick patients.

• Percutaneous Endoscopic Gastrostomy: This procedure is done for long term nutritional management of neurological patients who cannot swallow to maintain their nutrition.

• Endoscopic Retrograde Cholangiopancreatography: This is an advanced procedure which from a diagnostic tool has now acquired therapeutic dimension. Various treatments can be caused out using this procedure like:

  1. Bile duct stone removal

  2. Mechanical lithotripsy of large bile duct stones.

  3. Placing plastic /metallic stents for palliating or bypassing malignancies or treating biliary infections.

Our department has expertise in this and is a major referral centre in North India.

• Enteroscopy: To examine lesions of small intestine

• Double balloon Enteroscopy: Allow visualisation of entire small intestine and is recent technology. This procedure has a therapeutic potential also.

• Sigmoidoscopy & Colonoscopy: To look for diseases of large intestine like ulcers, tumors, polyps, and diverticulosis, AVMs and at times to treat these too.

• Polypectomy: For removal of polyps which can be a cause of bleeding or having a malignant potential.

• pH monitoring: For confirmation of reflux disease & as a research tool.

• Manometry: Done to diagnose motility disorders.

• Endoscopic ultrasonography (EUS): It is a new technique, which is used to diagnose & stage cancers of digestive & hepatobiliary tract so as to optimise treatment of such patients. This technique can differentiate between benign and malignant lesions by doing FNAC (fine needle aspiration cytology). A number of therapeutic procedures can be carried out using EUS. This technique is available in very few centers in India and in Northern India, Sir Ganga Ram Hospital has both diagnostic and therapeutic EUS facilities. This technique is better than any other imaging modality for staging and diagnosis cancers.

• Capsule endoscopy: This procedure involves swallowing a capsule which has a video camera & takes pictures of GI tract which are recorded on an instrument & taken analysed on computer. This allows visualization of entire small intestine. This and double balloon Enteroscopy are complementary to each other.

• Liver biopsy: This procedure is done to diagnose diseases of the liver so as to give appropriate treatment.

• Transjugular Liver biopsy: Many patients suffering from liver disease have abnormal coagulation profile and are unfit to undergo biopsy. Such patients are taken up for this procedure, which is done under fluoroscopy. During this procedure one can be pressure measurement, which is a research tool and also helps in selecting patients for particular treatment.

• MARS dialysis (Molecular Adsorbent Recirculating System): Ours is one of the few centres in India to have this facility. This dialysis is a temporary measure in patients who are to undergo a liver transplant to stabilize them before the procedure. It is being carried out in patients who have fulminant hepatic failure.

These procedures are performed by experts in the field who are renowned all over India. Most of the procedures are done under conscious sedation so as to make the patients comfortable. Care is taken to sterilize the endoscopes properly to prevent any infections or cross infections.

The department runs a detailed academic programme for DNB residents undergoing fellowship in the superspecialty. This programme includes lectures, symposia, case discussion, bedside teaching and endoscopy training. Difficult and problem cases are discussed threadbare to reach proper diagnosis so that patients gets the benefit of so many minds working in the department. The residents are taught clinical and practical Gastroenterology & Hepatology. They learn both upper and lower GI endoscopies and are introduced to ERCP procedures. They are trained to do liver biopsies.

The department is actively involved in organising conferences for the benefit of fellow colleagues. The department has organised two recent conferences Endocon-2006, which was focused on GI malignancies & Mid term INASL Meet, which was focused on Renal involvement in Liver diseases. Every year our department presents papers in various national & international conferences. Our faculty is invited regularly on various national and international conferences to give talks & lectures and demonstrate the procedures.