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Centre Of Excellence In Gastroenterology And Minimal Access Surgery

Doctors Panel :

  • Dr. SREEJITH V ERATTE, MBBS, MD (JIPMER), DM (AIIMS), MEDICAL GASTROENTEROLOGIST & HEPATOLOGIST
  • Dr. ARUN S. NAIR, MBBS, MS, FNB (MAS), FMAS, FACS, FIAGES, MINIMAL ACCESS GASTRO & BARIATRIC SURGEON
  • Dr. RAVIRAM S, MBBS, MS, MCh, FMAS, SURGICAL GASTROENTEROLOGIST
  • Dr. ARUN KRISHNA A.K, MBBS, D.A, DNB, CHIEF ANAESTHETIST

Daya Hospital takes pride in having an advanced Medical and Surgical Gastroenterology tertiary care facility. Our aim is to provide evidence based treatment and holistic care to both adults and children suffering from Gastro-intestinal disorders.

The centre is equipped with well trained and highly qualified gastroenterologists, gastrointestinal & bariatric surgeons & nutritionist who involve in the prevention, diagnosis and treatment of digestive disease and associated ailments. The department is able to handle most complex cases with the help of cutting edge technologies, infrastructure and expertise of our team.

MEDICAL GASTROENTEROLOGY

The Medical Gastroenterology team has got a dedicated, qualified, experienced team which provides the clinical evaluation;Diagnostic work up including  state of the art laboratory, Imaging and endoscopy suites with focus on high end technology, emphasis on patient safety & disinfection protocols.   We have excellent supporting team which includes Interventional radiologist, GI pathologist, Critical care Specialists, ICU specialist and Anaesthesiologists

Broad Areas of Gastroenterology Specialty :

  • Gastroenterology/Hepatology
  • Advanced Liver Care centre (Liver Clinic)
  • Centre for Biliary and Pancreatic Disorders (Pancreas Clinic)
  • Centre for Luminal Disorders (IBD Clinic)
  • Diagnostic and Therapeutic Endoscopy and ERCP
  • Diagnostic and Therapeutic EUS
  • Centre for Swallowing and Oesophageal Disorders
  • Gastrointestinal Haemostasis (Hemetemesis&Malena)
  • Cancer detection and Palliation Unit
  • Paediatric Gastroenterology
  • Intensive Care Services (ICU)
  • Diagnostic Facilities
  • All forms of upper and lower gastrointestinal video-endoscopy (Endoscopy & Colonoscopy)
  • ERCP (Endoscopic Retrograde CholangioPancreatography)
  • Spy Glass Cholangioscopy
  • Endosonography (EUS)
  • Capsule Endoscopy
  • Motility studies
  • Ultrasound (USG)
  • High speed helical CT scans
  • MRI (with facilities for noninvasive cholangio and pancreatography and MR angiography)
  • Colour Doppler Studies
  • Fluoroscopic imaging of the liver, gall bladder, bile ducts, pancreas and intestinal tract

MEDICAL DEPARTMENT OFFERS:

  • Outpatient Services (Daily)
  • Inpatient services including Intensive Care Unit (ICU)
  • Day Care Services
  • Round the clock emergency services for gastrointestinal & HPB related problems (haemetemesis, malaena, foreign body removal etc)
  • Diagnostic and Therapeutic Upper GI Endoscopy (UGIE) with NBI (Narrow Band Imaging) which allows us to see Esophagus,Stomach,Part of Duodenum
  • Diagnostic and Therapeutic Colonoscopy  (LGIE) with NBI (Narrow Band Imaging)which allows us to visualize whole Colon and Terminal ileum
  • Capsule Endoscopy for non invasive evaluation of small bowel with a small “pill” which contains a camera; it  records thousands of images as the pill goes down the intestine. It is then analysed by the computer and interpreted by  doctors
  • Minimally Invasive Advanced Interventional Endoscopy services
  • ERCP (Endoscopic Retrograde Cholangio Pancreatography):To remove CBD,PD Stones,placement of plastic and metalic Stents to relieve jaundice
  • Spy Glass Cholangioscopy to Assess BD and PD Strictures to remove large intraductal stones
  • EUS (Endoscopic Ultrasound) which allows to visualize,assess and if required to take biopsy from various internal organs through endoscopy itself.Are also  used to stage cancers and treat patients with pancreatic pseudocysts, bile duct obstruction etc
  • Endoscopic treatment for Obesity with placement of Intragastric balloon

Gastrointestinal Physiology Lab:

We have dedicated Gastrointestinal Physiology Lab which performs PH metry, Esophageal and Anorectal manometry for patients with refractory or difficult to treat Gastroesophageal Reflux Disease (GERD)/Swallowing difficulties, Constipation and Fecal incontinence. We also offer biofeed back therapy for constipation and anal incontinence

Clinical Services:

The services offered by the Institute include:

Advanced gastrointestinal endoscopy services, both diagnostic and therapeutic

UPPER GI ENDOSCOPY

Diagnostic servicesfor  evaluation of :

  • Ulcer disease (Peptic Ulcer Disease)
  • Bleeding
  • NBI Assisted Techniques for early detection of Cancers/ polyps
  • Anemia
  • Vomiting

Therapeutic Services:

  • Foreign Body removal
  • Endoscopic Sclerotherapy/EVL Banding/Glue Injection/Clip Application for Hemetemesis
  • Argon Plasma Coagulation (APC) for Bleeding Lesions /GAVE
  • Polypectomy
  • Rigiflex Dilatation for Achalasia Cardia
  • CRE Dilatation for Benign Strictures
  • Percutaneous endoscopic gastrostomy (PEG) placement for feeding patients with swallowing difficulty
  • Naso-jejunal (NJ) tube placement for feeding of critically ill patients
  • Palliative Stenting for CaEsopahgus,Antral Stenting for GOO
  • IntragastricBaloon for Obesity
  • Endoscopic mucosal/ submucosal dissection for precancerous lesions and early cancers

COLONOSCOPY

Diagnostic services for:

  • Blood in stool
  • Long standing diarrhea (Chronic Diarrhea)
  • Colonic obstruction
  • Detecting cancers

Therapeutic services for :

  • Polypectomy for  colonic polyps
  • CRE Dilatation for Benign Strictures
  • Argon Plasma Coagulation (APC) for Bleeding Lesions
  • Colonic decompression
  • Tumor related obstruction (Endoscopic Metal Stent Placement)  
  • Colonic/ Piles Bleeding ( Banding/ Injection therapy/ Clip placement)
  • Endoscopic mucosal Resection (EMR)/ Submucosal Dissection (ESD) for precancerous lesions and early cancers

CAPSULE ENDOSCOPY

ENDOSCOPIC RETROGRADE CHOLANGIO-PANCREATICOGRAPHY (ERCP)

  • Removal of  common bile duct (CBD) and Pancreatic Duct stones
  • Endoscopic Management of Bile Leak/Injuries
  • Pancreatic duct stenting for  -Pancreatic duct stricture ,Pancreatico pleural Fistula  fistula ,Traumatic pancreatic duct disruption
  • Accessory pancreatic duct sphinchterotomy and stenting for Pancreas Divisum
  • Stenting for benign and malignant biliary and pancreatic duct strictures

SPYGLASS CHOLANGIOSCOPY

  • Endoscopic  visualization of the bile duct to assess bile and pancreatic ductstrictures,growth,removal of bile duct stones

ENDOSCOPIC  ULTRASOUND (EUS)

  • Diagnostic EUS
  • Detection of small bile duct stones and tumors
  • Diagnosis of early Chronic Pancreatitis
  • Evaluation of Pancreatic Cancers
  • Tissue acquisition from lymphnodes, and pancreatic lesions
  • EUS Guided Coil Embolisation of Fundal & Ectopic Varices
  • EUS guided FNAC
  • EUS guided therapeutic procedures (Endoscopic Cystogastrostomy for Pancreatic Pseudocyst (ECG)
  • EUS Guided Necrosectomy
  • EUS Guided Choledochoduodenostomy/Hepatogastrostomy
  • Evaluation of submucous lesions/ growth
  • Assessment of resectability of tumors
  • EUS Guided Celiac gangion block/neuronolysis for pain management in
  • chronic pancreatitis

MANOMETRY (ESOPHAGEAL & RECTAL)

  • High resolution esophageal manometry (HRM) for esophageal Motor disorders and swallowing Problems
  • 24-hour ambulatory pH-metry for Gastro Esophageal Reflex disease (GERD)
  • Anorectal Manometry for Severe constipation (due to pelvic floor dysfunction) and Fecal incontinence

FIBROSCAN OF LIVER

  • Transient elastography (Fibroscan) of liver for non-invasive diagnosis of liver fibrosis

PERCUTANEOUS  LIVER BIOPSY

OUTPATIENT ACTIVITIES

  • LIVER CLINIC

Liver Unit which mainly focuses on diagnosing the cause of liver problems and  optimising the treatment

State-of-the-art facilities for the complete diagnosis and management of whole spectrum of acute and chronic liver diseases, including:

  • Viral hepatitis
  • Alcoholic hepatitis
  • Lifestyle liver disorders-Fatty Liver, Non-alcoholic Steatohepatitis (NASH)
  • Drug-induced hepatitis
  • Autoimmune liver disease
  • Hematochromatosis
  • Wilson disease
  • Primary sclerosing cholangitis
  • Liver tumors, especially Hepatocellular carcinoma and Metastatic liver cancer
  • The devision conduct speciality clinics

Fatty liver clinic
Hepatitis clinic
Alcoholic liver clinic
Liver cancer clinic
Immunisation counseling

PANCREAS CLINIC:

Comprehensive care including detailed workups, diagnosis, medical or/and surgical treatment, when indicated, on an outpatient as well as inpatient basis

  • Acute Pancreatitis
  • Chronic Pancreatitis
  • Pancreatobiliary cancers
  • Pancreatic cystic disease

Diagnostic and Therapeutic Facilities

Facilities include Endoscopic retrograde cholangiopancreatography (ERCP), Multi-Slice CT scan, Magnetic resonance imaging (MRI), Magnetic resonance cholangiopancreatography (MRCP), pancreatic stenting, pseudocyst drainage, Endoscopic ultrasound (EUS), Endoscopic ultrasound-guided FNA (EUS-FNA), celiac plexus block, lithotripsy, etc

Management of Pancreatobiliary Cancers

Diagnostic facilities available include non-invasive tumor markers, endoscopic ultrasound (EUS) and EUS —FNA apart from all established imaging modalities. Non-surgical management including biliary drainage and stenting, etc. is available

CENTRE FOR GASTROINTESTINAL HAEMOSTASIS (GI BLEED)

A dedicated team of endoscopists, gastrointestinal surgeons, interventional radiologists, and vascular surgeons are available around the clock for treating patients with upper or lower gastrointestinal bleeding. A fully-monitored emergency ICU service, an outstanding blood bank which provides blood component therapy, and a 24 hour endoscopic and surgical service ensure immediate control of massive bleeding. Complex diagnostic and therapeutic modalities often avoid the need for high-risk surgery.

 

CENTER FOR SWALLOWING DISEASES

The unit caters to all patients with swallowing difficulty. These patients are evaluated extensively with video fluoroscopy, imaging modalities and manometry treatment offered to patients with achalasia cardiainclude , pneumatic balloon dilatation and Botulinum toxin injection.

LUMINAL GASTROENTEROLOGY UNIT (IBD & ITB CLINIC)

We also have a focused team which deals with Gastrointestinal Luminal problem like inflammatory bowel disease (Ulcerative Colitis and Chrohn’s Disease) chronic diarrhea,intestinal TB, intestinal motility disorders. These patients often require regular follow-up, endoscopic procedure and in certain difficult to treat patients initiating specialised treatment with biologicals.

 

SURGICAL TEAM

SURGICAL GASTROENTEROLOGY AND MINIMAL ACCESS SURGERY

The department of surgical gastroenterology takes care of clinical problems of digestive tract that requires surgical intervention. The department is supported by skilled surgeons specialised in conventional open and advanced laparoscopic surgeries.

The three domains of this speciality include upper GI surgery (stomach and esophagus), colorectal surgery( small intestine, large intestine, rectum and perianal problems) and HPB surgery( liver, biliary tract and pancreas). Endoscopy and laparoscopic expertise are incorporated in to these domains to provide comprehensive, protocol based treatment to all gastrointestinal problems.

The surgical department is equipped with advanced, ultra clean, state of the art modular operating room facilitated with High definition laparoscopic unit, a modern operating suite and advanced energy sources for bloodless precise surgery.

A well trained anesthesia team in combination with our team of intensivistsand a well-equipped ICU for postoperative care ensures that all major and complex surgeries are performed safely and successfully.

The surgical facility will soon be rolling out the robotic surgical unit which will improve the surgical precision and minimise blood loss and ensure excellent postoperative functional outcome

Areas of Clinical Expertise Include:

Upper GI surgery

We have a team of surgeons who have done focused training in international centres for diseases of the upper GI system – stomach and esophagus. We have an excellent facility for evaluating diseases of esophagus & stomach that includes endoscopy, manometry and pH studies. Minimally invasive surgical treatment is being provided for a range of diverse conditions including laparoscopic fundoplication for reflux disease, Heller’s myotomy for achalasia cardia and thoracolaparoscopicesophagectomy for esophageal cancers and gastrectomies for stomach cancers

Oesophagus : 

  • Heller’s Myotomy for Achalasia/treatment for other motility disorder
  • Anti-reflux surgery like lap fundoplication for GERD
  • Laparoscopic / Thoracoscopic oesophagectomy
  • Laparoscopic Resection for oesophageal diverticula
  • Laproscopic surgery for Hiatus Hernia
  • Management of corrosive injuries of oesophagus

Stomach :

  • Laparoscopic& open gastric surgeries for benign & malignant diseases

Colorectal surgery

We offer a one stop solution for the problems of the small bowel, colon, rectum and anal canal in the division of colorectal surgery. After thorough evaluation with a wide range of modalities including colonoscopy, CT/MRI, enteroscopy and manometry, complex problems including inflammatory bowel diseases, polyposis syndromes, intestinal tuberculosis and cancers of small and large bowel are managed with a tailored surgical treatment that entails a minimally invasive and function preserving approach. Laparoscopic small bowel resections, hemicolectomy, subtotal colectomies, ileoanal pouch surgeries are performed. Surgical treatment is also provided for common perianalproblems including piles, fissure and fistula.

Small Bowel :

  • Open or Laparoscopic Small Bowel Resection and Anastomosis
  • Open or Laparoscopic surgery for Full Thickness Small Bowel Biopsy
  • Open or Laparoscopic surgery for Small Bowel Perforation Closure
  • Open or Laparoscopic surgery for Adhesiolysis

Colon & Rectum

  Open or laparoscopic surgeries for cancer, inflammatory bowel diseases, polyposis syndromes and abdominal tuberculosis.

These include:

  • Laparoscopic surgery for Appendicectomy
  • Laparoscopic surgery for Left/Right Hemicolectomy
  • Open or Laparoscopic surgery for Total Colectomy and Ileostomy
  • Open or Laparoscopic surgery for Restorative Proctocolectomy, IPAA
  • Laparoscopic Rectopexy for prolapsed rectum

Anorectal :

  • Malignancies
  • Hemorrhioides/piles
  • Fissures
  • Fistula
  • Pilonidal sinus

HPB Surgery:

HPB surgery includes disorders of the liver, biliary tract and pancreas and is a highly challenging area of GI surgery. Diagnosis of HPB disorders are always tricky and surgery of these regions are hugely challenging owing to complex resections involved and the anatomical variations. Backed by cutting edge technology including spyglass and endoscopic ultrasound in addition to the routine endoscopy and ERCP our team is able to bring down the diagnostic dilemma. Trained in prominent high volume centres of national & international importance our surgeons are able to provide a tailored solutions to the complex problems thrown up by HPB surgery. Complex resections like Whipple’s procedure, liver resections,  radical cholecystectomy and bile duct resections are being done in the department

  Liver

  • Laparoscopic deroofing/ excision of liver cysts
  • Hemihepatectectomies
  • Resection for liver metastasis

Pancreas

  • Laparoscopic/open surgery for chronic pancreatitis – Freys, Begers
  • Open/ laparoscopic Pancreaticoduodenectomies – Whipples procedure
  • Pancreatic necrosectomy
  • Laparoscopic cystogastrostomy/ cystojejunostomy

Biliary tract

  • Laparoscopic cholecystectomy
  • Radical cholecystectomy
  • Bile duct excision for cholangiocarcinoma
  • Laparoscopic bile duct excision for choledochalcyst
  • Surgery for recurrentpyogeniccholangitis – hepaticojejunostomy, choledochoduodenostomy
  • Laparoscopic CBD exploration for bile duct stones

Hernia Care

Hernias are caused by a weakness that results in a defect in the abdominal wall through which the intra-abdominal contents protrude out.  Its a common problem people fail to realise. The benefits of an early surgical intervention that improves surgical results and reduces complications. We have an excellent team of surgeons who are well versed in the laparoscopic treatment of a variety of hernias including inguinal, umbilical, ventral & incisional hernias. Our team prides itself in delivering comprehensive care to these patients helping them recognise the importance of treatment, minimally invasive surgery, post operative counselling regarding the dos & donts. We are planning to provide day care surgery for these patients.

  • Laparoscopic total extraperitoneal (TEP)repair for inguinal hernia
  • Laparoscopic trans abdominal preperitoneal (TAPP)repair for inguinal hernia
  • Laparoscopic Intra peritoneal on lay repair (IPOM) for umbilical, ventral & Incisional Hernia

Bariatric Surgery

            We have an experienced bariatric surgery team who in addition to performing minimally invasive surgery on these difficult patients, offer an arm of support to these patients to relieve their anxiety and clear their doubts. These patients undergo a detailed evaluation for their comorbid conditions and their post-operative diet is well charted out. Both restrictive &malabsorptive procedures are done depending on the patient factors

Endoscopic Thyroidectomy

            Trained under the pioneer of endoscopic thyrodectomy, our team of surgeons offer a novel minimally invasive method for patients with thyroid disorders to avoid a neck scar that can be ugly and a source of embarrassment, especially for females. Ours is one of the very few centres in Kerala that offers this facility