Dr Ajesh Bansal

PROCEDURES

UPPER GI ENDOSCOPY

An upper endoscopy can be used to determine the cause of heartburn and is often performed as an outpatient procedure. Upper endoscopy uses a thin scope with a light and camera at its tip to look inside of the upper digestive system -- the esophagus, stomach, and the first part of the small intestine, called the duodenum. During endoscopy, certain procedures such as taking a small tissue sample (biopsy) for testing may be performed.

In addition to heartburn, the procedure may also be used to help evaluate 
  • Upper abdominal pain
  • Nausea and vomiting
  •  Stomach bleeding
  • Swallowing disorders

Endoscopy can also help identify inflammation, ulcers, and tumors. Upper endoscopy can be more accurate than X-rays or other imaging for detecting abnormal growths and for examining the inside of the upper digestive system.

Indications of UGI endoscopy
  • Chronic diarrhea
  •  Bleeding (red or coffee colored blood) from mouth
  • Difficulty in swallowing food
Therapeutic procedures that can be Done during endoscopy :-
  • Banding of varices
  •  Endoteharpy of ulcers
  • Polyp removal
  • Foreign body removal
  • Dilatation of strictures
  • APC application for GAVE/PHG/PGP
  • Stenting of esophagus and duodenum

SIGMOIDOSCOPY/ COLONOSCOPY

Colonoscopy and Sigmoidoscopy are screening tests that use a thin flexible tube with a camera at the end to look at the colon but differ in the areas they can see. A colonoscopy examines the entire colon . The colonoscope is a four-foot long, flexible tube about the thickness of a finger with a camera and a source of light at its tip. The tip of the colonoscope is inserted into the anus and then is advanced slowly, under visual control, into the rectum and through the colon usually as far as the cecum, which is the first part of the colon.

If a pre-cancerous polyp or cancer is found, you’ll need to have a colonoscopy later to look at the rest of the colon. But sometimes only the rectum and sigmoid colon need close inspection. A sigmoidoscopy, also called a flexible sigmoidoscopy, is a procedure that lets your doctor look inside your sigmoid colon by using a flexible tube with a light on it. It helps your doctor check for:

  • ulcers
  • abnormal cells
  • polyps
  • cancer
Indications for colonoscopy
  • Pain in lower abdomen
  • Bleeding from the anus
  • Loose motions with blood in stool
  • CECT or ultrasound showing mass in the colon
  • Suspicion of ulcers in small bowel
  • Screening colonoscopy after the age of 50 years for early detection of cancer/premalignant lesions
Therapeutic indication for colonoscopy
  • Polypectomy
  • Endotherapy of bleeding ulcers
  • Stenting of the colon in malignant obstruction 

Endoscopic retrograde cholangiopancreatography (ERCP)

Endoscopic retrograde cholangiopancreatography (ERCP) is a specialized technique used to study and treat problems of the liver, pancreas and, on occasion, the CBD Stones. ERCP is performed under sedation. Generally, the level of sedation for ERCP is deeper than upper endoscopy and colonoscopy due to the complexity and length of the procedure.

What kind of Diseases Diagnosed by ERCP?

ERCP can be used to diagnose biliary colic, jaundice, elevated liver enzymes, cholangitis (inflammation of a bile duct), pancreatitis (inflammation of the pancreas), and bile-duct (biliary) obstruction due to CBD Stones (choledocholithiasis) and cancer. ERCP can be used to treat CBD Stones, malignant and benign biliary strictures, cholangitis, pancreatic cancer and pancreatitis. Traditionally, ERCP was used as both a diagnostic and therapeutic endoscopic tool for evaluating diseases of the bile ducts, pancreas and CBD Stones. With improved Magnetic Resonance Imaging (MRI) and the emergence of endoscopic ultrasound (EUS), ERCP is now primarily a therapeutic instrument for treating conditions of the bile ducts and pancreas.


Indications:-Removal of common bile duct or pancreatic duct stones
  • Removal of worm form CBD or pancreatic duct
  • Jaundice due to obstruction of bile duct by compression due to lymph node or cancer.
  • Sphincter of oddi dysfunction 
  • Biliary ascites due to leakage of bile from bile duct. 
  • Stricture in common bile duct after surgery 
  • Chronic pancreatitis with stricture in the main pancreatic duct.
  • Pancreatic ascited because of pancreatic duct fluid leak .
  • Tumor of gall bladder, ampulla, pancreas and bile duct leading to common bile duct obstruction. 

ERCP is a safe procedure in expert hands, and is performed on day care basis, however serious complications like cholangitis, pancreatitis, perforation can occur in 1-3% of cases, which may require longer hospital stay

Capsule endoscopy

Capsule endoscopy is a procedure that uses a tiny wireless camera to take pictures of your digestive tract. A capsule endoscopy camera sits inside a vitamin-size capsule you swallow. As the capsule travels through your digestive tract, the camera takes thousands of pictures that are transmitted to a recorder you wear on a belt around your waist.
Capsule endoscopy helps doctors see inside your small intestine — an area that isn't easily reached with more-traditional endoscopy procedures. Traditional endoscopy involves passing a long, flexible tube equipped with a video camera down your throat or through your rectum.
Capsule endoscopy has also been approved

  • For the screening of the colon for colon polyps for those for whom a colonoscopy couldn't be completed.
  • To evaluate the muscular tube that connects your mouth and your stomach (esophagus) to look for abnormal, enlarged veins (varices).
Indications of Capsule Endoscopy
  • The most frequent indication for performing a capsule endoscopy is the evaluation of obscure GI bleeding.
  • Patients who have unexplained iron deficiency anemia or are losing blood from an unknown source in the GI tract are first evaluated with a colonoscopy and upper endoscopy (EGD).
  • However, if these exams show no identifiable source of blood loss, then a capsule endoscopy study is the next step in trying to find the cause of the bleeding.
  • Other causes of bleeding from the small bowel include ulcerations, erosions, inflammation, tumors, masses, or rare hereditary conditions.
  • Another common indication for capsule endoscopy is evaluation for Crohn's Disease. Crohn's is an inflammatory bowel disease which can affect the small intestine causing pain, inflammation, ulceration, and bleeding.

Bariatric Endoscopy

With the evolution of society and changes in human lifestyle, obesity is becoming increasingly prevalent worldwide, and obesity-related comorbidities such as diabetes, hyperlipidemia, hypertension, and coronary heart disease are more common.

Medications do not work very well for long-term weight loss. Surgery is not the best option for those who need to lose a moderate amount of weight because of increased risks, fear and expenses. New weight loss treatments are being developed using simple techniques that involve the use of scopes. This field is called bariatric endoscopy (or endobariatrics) and it fills the gap between surgery and medications.


Methods of Bariatric Endoscopy
  • Endoscopic intragastric balloon
  • Swallowable intragastric balloon
  • Endoscopic sleeve gastroplasty
  • Endoluminal vertical gastroplasty
  • Transoral gastroplasty
  • Primary obesity surgery endolumenal
  • Transoral endoscopic restrictive implant system
  • Articulating circular endoscopic stapler

Therapeutic approach to obesity treatment. The effect of endoscopic bariatric treatment for weight loss is greater than that of drugs but lower than that of bariatric surgery, but endoscopic bariatric treatment features fewer complications than bariatric surgery. VBG, vertical band gastroplasty; RYGB, Rouxen-Y gastric bypass; DS, duodenal switch; BPD, biliopancreatic diversion.

ENDOSCOPIC CYSTOGASTROSTOMY

Cystogastrostomy is a surgery to create an opening between a pancreatic pseudocyst and the stomach when the cyst is in a suitable position to be drained into the stomachThis conserves pancreatic juices that would otherwise be lost.This surgery is performed by a pancreatic surgeon to avoid a life-threatening rupture of the pancreatic pseudocyst.

A relatively new and less-invasive method involving endoscopic ultrasound  guidance and fluoroscopy. A large bore needle is used to access the identified pseudocyst, creating a fistula between the cystic cavity and either the stomach or the duodenum. Plastic stents may be placed to facilitate drainage from the pseudocyst. It is being presently done for colstridium difficut colitis and steriod depended/steriod Refractry ulceraline colitis.


  • FECAL MICROBIOTA TRANSPLANT(FMT)

    Fecal Microbiota Transplant (FMT) is a procedure in which fecal matter, or stool, is collected from a tested donor, mixed with a saline or other solution, strained, and placed in a patient, by colonoscopy, endoscopy, sigmoidoscopy, or enema. The purpose of fecal transplant is to replace good bacteria that has been killed or suppressed, usually by the use of antibiotics, causing bad bacteria, specifically Clostridium difficile, or C. diff., to over-populate the colon. This infection causes a condition called C. diff. colitis, resulting in often debilitating, sometimes fatal diarrhea.


    HIGHLY EFFECTIVE TREATMENT
    • Fecal Transplant is a low-cost, low-risk, highly effective treatment. It is not currently covered by most insurance companies, as it is still classified as an experimental treatment.
    • The Fecal Transplant Foundation was created to raise awareness of this life saving treatment, to help patients and physicians, and to accomplish the many goals in our Mission Statement.
    Indications of FMT
    • FMT is most widely used, and now recommended, in the indication of Clostridium difficile infection (CDI) CDI is an ideal condition for FMT, since it is primarily a GI dysbiosis with Clostridium difficileovergrowth.
    • CDI has traditionally yet counterintuitively been treated with antibiotics such as metronidazole, vancomycin, and, more recently, fidaxomicin or rifaximin. However, antibiotic therapy results in further microbiota damage and in recurrence rates of at least 20 %, which rise with each subsequent CDI episode.
    • Furthermore, antibiotics do not correct the abnormal microbiome but, rather, potentiate the problem. Conversely, FMT corrects the imbalanced microbiota that underlies CDI pathogenesis by providing the patient with a healthy microbiota that has a structural and functional homeostasis derived from a suitable donor.
  • HYDROGEN BREATH TEST

    The hydrogen breath test is a test that uses the measurement of hydrogen in the breath to diagnose several conditions that cause gastrointestinal symptoms. In humans, only bacteria - specifically, anaerobic bacteria in the colon - are capable of producing hydrogen. The bacteria produce hydrogen when they are exposed to unabsorbed food, particularly sugars and carbohydrates, but not proteins or fats. Although limited hydrogen is produced from the small amounts of unabsorbed food that normally reach the colon, large amounts of hydrogen may be produced when there is a problem with the digestion or absorption of food in the small intestine, that allows more unabsorbed food to reach the colon.

    When is it done?
    • Sugar intolerance
    • Small intestinal bacterial overgrowth
    How it is performed?

    Prior to hydrogen breath testing,

    • the patient fasts for at least 12 hours.
    • At the start of the test, the patient blows into and fills a balloon with a breath of air.
    • The concentration of hydrogen is measured in a sample of breath removed from the balloon. The patient then ingests a small amount of the test sugar (lactose, sucrose, sorbitol,fructose,lactulose, etc.depending on the purpose of the test). Additional samples of breath are collected and analyzed for hydrogen every 15 minutes for up to five hours

    Argon Plasma Coagulation

    Argon plasma coagulation or APC is a medical endoscopic procedure used primarily to control bleeding from certain lesions in the gastrointestinal tract, and also sometimes to debulk tumours in the case of patients for whom surgery is not recommended. It is administered during esophagogastroduodenoscopy or colonoscopy.
    Argon plasma coagulation (APC) is a non-contact thermal method of hemostasis that has generated much attention and excitement in recent years. It was introduced as an alternative to contact thermal coagulation (heater probe and bipolar cautery) and to existing non-contact technologies (primarily laser).


    APC is used to treat the following conditions:-
    • angiodysplasias, anywhere in the GI tract
    • gastric antral vascular ectasia, or watermelon stomach
    • colonic polyps, after polypectomy
    • radiation proctitis
    • esophageal cancer

    Foreign Body Removal

    Foreign body retrieval is the removal of objects or substances that have been introduced into the body. Objects may be inhaled into the airway, swallowed or lodged in the throat or stomach, or embedded in the soft tissues. About 80 percent of foreign body ingestions occur among children. Most foreign bodies pass through the gastrointestinal tract without complication, and endoscopic or surgical intervention is required only 10 to 20 percent of the time. Foreign bodies in the throat or stomach: Some ingested foreign bodies cause no symptoms. Alternatively, the patient may experience a sensation of something being stuck in their throat or esophagus. Drooling and difficulty swallowing are common symptoms. A small sharp object may become lodged in the esophagus and cause pain, even though they are able to swallow. Larger foreign bodies can partially or completely obstruct the stomach, the small intestine or, in rare cases, the large intestine, causing cramps, bloating, loss of appetite, vomiting, and sometimes fever. A sharp object that pierces the stomach or intestines can cause severe abdominal pain, fever, fainting and shock

    Metal Stent for Esophageal Carcinoma

    Esophageal stents have been used to palliate patients with dysphagia caused by esophageal cancer. Early rigid plastic prostheses have been associated with a high risk of complications. However, with the development of self-expanding stents, it has developed into a widely accepted method for treating malignant esophageal strictures and esophagorespiratory fistulas (ERFs). 

    Esophageal cancer is one of the most common malignancies and a major cause of cancer-related deaths worldwide.

    • Over 50% esophageal cancers are found to be incurable at the time of diagnosis because of metastases
    • Dysphagia is the most common symptom of incurable esophageal cancer. The aim of esophageal stenting is to restore luminal patency and thereby maintain oral intake and improve quality of life. However, this procedure carries a risk of major complications such as bleeding and perforation

    LIVER BIOPSY AND FIBROSCAN

    A 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. Your doctor may recommend a liver biopsy if blood tests or imaging studies suggest you might have a liver problem. A liver biopsy is also used to determine the severity of liver disease. This information helps guide treatment decisions.

    Indications of liver biopsy
    • Raised liver enzymes of unknown cause.
    • Staging of chronic hepatitis B and C/autoimmune hepatitis and Wilson disease.
    • Sampling of liver lesions.
    • Liver biopsy is a is a safe procedure Severe complication can occur in 1 in 50,000 procedures.
      FibroScan is a non-invasive device that assesses the ‘hardness’ (or stiffness) of the liver via the technique of transient elastography. Liver hardness is evaluated by measuring the velocity of a vibration wave (also called a ‘shear wave’) generated on the skin.
      The FibroScan device is approved for liver elastography measurements in patients with known chronic liver disease and particularly for patients with chronic hepatitis C. The test is simple, non-invasive and painless, and can help your doctor estimate the severity of fibrosis in your liver which may help with treatment and monitoring decisions.

    MANOMETRY

    Manometry is the measurement of pressure within liquids or gases using a device called a manometer. It is commonly used in fluid mechanics, medical diagnostics, and industrial applications. Manometers can be U-tube, digital, or inclined, depending on the precision required. This technique helps monitor pressure differences in pipelines, respiratory systems, and laboratory experiments.

    Indications of Manometry:
    • Gastrointestinal Disorders – Assesses conditions like fecal incontinence and chronic constipation.
    • Anorectal Disorders – Assesses conditions like fecal incontinence and chronic constipation.
    • Urological Assessments – Measures bladder pressure in patients with urinary dysfunction.
    • Industrial Applications – Used in pipelines, HVAC systems, and fluid mechanics to monitor pressure changes.

    OSEPHEGIAL

    The esophagus is a muscular tube that connects the throat (pharynx) to the stomach, allowing food and liquids to pass. It plays a crucial role in digestion by moving swallowed substances through coordinated muscle contractions called peristalsis. The lower esophageal sphincter (LES) prevents stomach acid from flowing back into the esophagus. Disorders like GERD, achalasia, and esophagitis can affect its function and cause discomfort.

    Indications of Osephegial
    • Gastroesophageal Reflux Disease (GERD) – Chronic acid reflux causing heartburn and irritation.
    • Esophageal Motility Disorders – Conditions like achalasia that affect swallowing and movement.
    • Esophageal Strictures – Narrowing of the esophagus due to scarring, making swallowing difficult.
    • Esophageal Cancer – Symptoms like difficulty swallowing, weight loss, and chest pain.
    • Esophagitis – Inflammation of the esophagus due to infections, acid reflux, or allergies.

    ANORECTAL AND BIOFEDBACK THERAPY

    Anorectal biofeedback therapy is a non-invasive treatment used to retrain bowel function and pelvic floor muscles. It is commonly used for conditions like fecal incontinence, chronic constipation, and pelvic floor dyssynergia. The therapy involves sensors that provide real-time feedback to help patients improve muscle coordination. It is a safe and effective technique to restore normal bowel control and improve quality of life.

    Indications of Anorectal And Biofedback Therapy
    • Fecal Incontinence – Helps strengthen and retrain anal sphincter muscles for better control.
    • Chronic Constipation – Treats pelvic floor dysfunction and improves bowel coordination.
    • Pelvic Floor Dyssynergia – Corrects improper muscle relaxation during defecation.
    • Post-Surgical Recovery – Aids in regaining bowel control after anorectal surgery.
    • Irritable Bowel Syndrome (IBS) – Assists in managing bowel irregularities and discomfort.