Gastroenterology and Liver Care

The Gastroenterology department at P. D. Hinduja Hospital, Mumbai provides prevention, diagnosis and treatment of various gastrointestinal and hepatology disorders. It includes disorders of esophagus, stomach, small and large intestines, gall bladder, pancreas and liver, which may be simple like jaundice to complex like IBD or cancer. The Gastroenterology and Liver care section has been ranked amongst the top 10 departments in India, consistently.

A. Medical Gastroenterology and Hepatology (Liver)
The department deals with various medical problems in gastroenterology in the outpatient, inpatient and emergency services setting. The doctors have expertise in the management of the full spectrum of gastrointestinal, liver and pancreatico-biliary diseases. This includes, but is not restricted to, disorders like inflammatory bowel disease, irritable bowel syndrome, malabsorption syndrome, gastrointestinal bleed, chronic diarrhea, constipation, peptic ulcer, reflux disease, acute liver failure, chronic liver disease (viral, alcoholic and others), portal hypertension, bilio-pancreatic disorders and malignancies, crohn's diseases, pancreatitis, ulcerative colitis, celiac diseases, gastrointestinal bleeding, hepatitis, chronic and acute liver diseases, peptic ulcers etc.

B. Pediatric Gastroenterology
This is a subspecialty in medical gastroenterology that deals with children suffering from various disorders like chronic constipation, Hirschsprung's disease, malabsorption syndrome, acute viral hepatitis, inborn errors of metabolism, Wilson's disease, pediatric inflammatory bowel diseases.

C. Liver Transplantation
In addition to the various liver disorders listed above, we run a liver transplant program along with the surgical and intensive care transplant team; this service is registered with the state Zonal Transplant Co-ordination Committee.

D. Interventional Gastroenterology
We have a well-equipped endoscopy department where diagnostic, therapeutic as well as emergency procedures in gastroenterology are performed. We also perform procedures like percutaneous and transjugular liver biopsy, HVPG monitoring and TIPSS placement.

UGI Endoscopy: Examination of the upper gastrointestinal tract using a flexible video-endoscope. Diagnostic – for disorders like acid-peptic disease, H. pylori infection, gastro-esophageal reflux disease, cancers of the esophagus and stomach.

Therapeutic – for management of emergencies like variceal bleeding (procedures like sclerotherapy, variceal banding), endoscopic therapy for bleeding peptic ulcer by injection, application of hemoclips or thermal current, placement of percutaneous endoscopic gastrostomy (PEG) tube or jejunostomy as a feeding device for neurologically impaired individuals or those who are unable to swallow. We also perform endotherapy for early cancers and place stents for palliation of obstructive malignant lesions.

Colonoscopy: Examination of the lower gastrointestinal tract using a flexible video-endoscope. Diagnostic – for disorders like polyps, cancers, strictures, bleeding sites, diverticuli.

Therapeutic – for management of colonic obstruction with stenting, endotherapy for lower gastrointestinal bleeding, and polypectomy.

ERCP (Endoscopic retrograde cholangio pancreatography): This procedure involves treating various bilio-pancreatic disorders. These include obstructive jaundice caused by common bile duct stones (extraction of the stones) or relieving obstruction in bilio-pancreatic cancers by placement of plastic or metal stents. ERCP also aids in obtaining tumor tissue cytology / biopsy from the bile duct to confirm the diagnosis in suspected cases of malignancy. We also treat chronic pancreatitis and perform pseudocyst drainage in acute or chronic pancreatitis by placing plastic stents

EUS – Endoscopic ultrasonography: This procedure involves performing ultrasound examination with a probe attached at the tip of an endoscope. It allows detailed visualization of the walls of the esophagus, stomach, duodenum, as well as the pancreas, bile duct, other adjacent organs, lymph nodes and blood vessels. This allows quicker and definitive diagnosis of various diseases, staging of cancers, and thus aids in management. EUS is also helpful in procuring tissue for examination. It aids in difficult biliary and pancreatic therapeutic endoscopic procedures.

Capsule Endoscopy: This is a painless procedure in which the patient swallows a capsule with an inbuilt camera that takes and transmits photographs of the intestine, helping in diagnosis and planning treatment of various conditions, e.g., localizing the site and cause of intestinal bleeding, chronic diarrhea, polyps and tumors in the small intestine.

Manometry: In this procedure, pressures in the esophagus, stomach, duodenum and anorectal region are measured, aiding in diagnosis of disorders like achalasia cardia, pelvic floor dysfunction, Hirschsprung's disease, chronic constipation and incontinence.

Hydrogen Breath Test: This is a non-invasive test that measures hydrogen exhaled in the breath, to diagnose disorders like malasbsorption, small intestinal bacterial overgrowth syndrome and short bowel syndrome.

Urea Breath Test: This is a modality for non-invasive diagnosis of Helicobacter pylori infection without performing an endoscopy, in patients with dyspepsia; it also confirms eradication after treatment of H. pylori infection.

GI Radiology

We have a well-equipped department of interventional radiology that performs procedures like;

• Transjugular liver biopsy
• Measurement of hepatic venous pressure in cirrhosis of liver by HVPG
• Liver cancer treatment procedures like:
• Chemoembolization: injection of chemotherapeutic agents into blood vessels supplying the liver tumor.
• Radiofrequency ablation: ablating tumor tissue by radiofrequency waves.
• Therasphere: injection of radioactive agent into liver tumors.
• CT scan-guided / Ultrasonography-guided procedures like:
  • Liver biopsy
  • Liver lesion biopsy
  • Pancreatic biopsy
  • Abdominal lymph node biopsy
  • Abscess drainage
  • Percutaneous transhepatic biliary drainage for relieving jaundice due to obstruction of bile duct - Bile duct stenting for cancers
  • Angiography – Diagnostic and treatment of gastrointestinal bleeding, treatment of aneurysms