Friday, January 31, 2014

WATCH LIVE http://mcldindia.com/live.htm

Eminent Liver Experts from across the World come together for a an International Liver Conclave organized by Global Hospitals Group at Chennai, INDIA.

2 Living Donor Liver transplants (2 donors, 2 recipients, a total of 4 surgeries) to be performed LIVE by the team of Global Health City 400 experts doctors from India and around the world to participate in discussions on the latest advances in the field of 'Care of Liver Transplant patient'

The Director of the Programme, Prof. Mohamed Rela, translated his experience and expertise to benefit 12 Indian patients waiting on the list for liver transplantation at Global Hospitals. The Global Hospitals Liver Transplant team has performed 6 split liver transplantations leading to 12 patients (5 adults & 7 children) who have now bounced back to normal life after transplantation. The Global Hospitals liver transplant unit at Chennai has performed close to 300 Liver transplants of which 80 have been done on children. In addition to the excellent multidisciplinary clinical care that is provided to the patients with Liver disease at Global Hospitals, there has been a mutual interest from the specialists in the team and from International Experts in the field of transplantation to hold discussions and deliberations regarding the situations faced while dealing with patients who are undergoing a liver transplantation procedure.

In its endeavor to create a platform to bring together stalwarts to share their knowledge and experiences on key issues pertaining to health, Global Health City, part of the Global Hospitals Group is organizing the "4th Master Class in Liver Disease Conference" from 31st Jan to 2nd Feb, 2014. The focal area for the conference will be "Peri-Operative Care of the Liver Transplant Recipient" this year

Friday, January 17, 2014


Emergency Medical support services and Ambulance serivecs to Eid Milad-un-Nabi processions
Hyderabad, January 14th 2014: As a corporate social responsibility Aware Global Hospitals has provided Free Emergency Medical support services and Ambulance serivecs to Eid Milad-un-Nabi processions in old city hyderabad on 14th January 2014. About a lakh people participated in the processions. Organizing committee of Milad-un-Nabi processions has expressed deep gratitude for the services provided by Global Hospitals.

Thursday, January 9, 2014


Per Oral Endoscopic Myotomy for Achalasia cardia: Tunnelling the esophagus. 
 
With the advent of NOTES (Natural Orifice Transluminal Endoscopic Surgery) there has been a recent addition of an incisionless surgery called Per Oral Endoscopic Myotomy (POEM) in the treatment armamentarium of achalasia cardia.

We report a 52 years female otherwise healthy but symptomatic for progressive dysphagia since 12 years. For the past six months she had worsening of symptoms associated with vomiting, nasal and oral regurgitation and weight loss of 16 kgs. She was diagnosed as Achalasia cardia based on endoscopic, barium and high resolution manometric findings. Prior to the procedure resting LES pressure on HRM was 69.8 mmHg. Her Eckardt dysphagia score was 9/12.  She underwent pneumatic balloon dilation once without any symptom relief. She was then offered laparoscopic Heller’s myotomy and POEM. She opted for POEM. 

She underwent POEM under general anaesthesia.  We used a high definition endoscope (Olympus GIF H180) and transparent cap (Olympus MH 588).  An incision was made in the mucosa 15cms above the GE junction using a hybrid knife ( electrogenerator, Erbe Vio 300D; Erbe Elektromedizin, Germany)   . This mucosal incision was made after submucosal instillation of saline along the right anterolateral esophageal wall. The endoscope was then inserted into the submucosa at the site of incision and a submucosal tunnel was created from the incision till 1 cm beyond GE Junction. Spray coagulation mode was used to dissect the submucosa. Continuous infiltration of a solution made of 100ml saline mixed with indigocarmine and 1 ml adrenaline was done to separate the mucosa and to detect any small mucosal tear. A coagulating forceps (FD-410LR Coagrasper; Olympus) was used for hemostasis as needed. The time required for creating the tunnel was 53 mins. The GE junction was identified by palisade vascular pattern and premeasured distance from the incisors. The endoscope was then withdrawn from the tunnel and introduced in the esophagus to look for any mucosal break.  The endoscope was re-inserted in the tunnel and muscle cutting was started 4 cms below the mucosal incision. Circular as wells as longitudinal muscle of the esophagus were incised very gently in millimetres so as to avoid injury to the adjacent mediastinal structures. The muscle cutting was continued till the end of the tunnel. The total muscle cutting time was 25 mins. There was a tiny mucosal break which was closed with a standard endoscopic hemoclip. The mucosal incision was finally closed with six endoscopic clips (HX-110UR EZ Clip Reusable Rotatable Clip Fixing Device and HX-610-135L Single Use Clips; Olympus).

Since the time we reported first case of POEM from India so far we have performed 75 cases till date.

Dr. Amit Maydeo
Director, Baldota Institute of Digestive Sciences, Global Hospitals Mumbai
Dr. Nitin Joshi, BIDS.
Consultant Gastroenterologist
Dr. S P Bhandari, BIDS.
Consultant Endoscopic Surgeon
Dr. Mukta Bapat
Consultant Gastroenterologist, BIDS.
Dr. Vinay Dhir
Chief of Endosonography and Head Clinical Research, BIDS.

Friday, January 3, 2014

Removable fully covered metal stent for Chronic Pancreatitis post Lateral pancreatic jejunostomy New stent



Removable fully covered metal stent for Chronic Pancreatitis post Lateral pancreatic jejunostomy New stent 

18 Year old female patient, case of chronic pancreatitis underwent Lateral pancraetico jejunostomy. Presented with recurrent abdominal pain and nausea 1 year later. MRCP showing PD stricture in the head and neck of pancreas.    

  MRCP


Patient under went ERCP and stenting with 5 french stent Patients pain reduced. After 3 months pain recurred. ERCP done showed a blocked stent stent was replaced by 7french stent after 3 months pain reurred
 
  ERCP Stenting

Patient was given Option of surgey which she refused young girl with already one big scar then the new stent Removable Bumpy stent was planned.


Endoscopy. 2012 Sep;44(9):874-7. doi: 10.1055/s-0032-1309774. Epub 2012 Jul 23.

Fully covered self-expanding metal stents for refractory pancreatic duct strictures in chronic pancreatitis. Giacino C, Grandval P, Laugier R.

Fully covered self-expanding metal stents (FC-SEMSs), which can be removed from the bile duct, have recently been used in the main pancreatic duct (MPD) in chronic pancreatitis. The aim of this study was to investigate the feasibility, safety, and efficacy of FC-SEMSs in painful chronic pancreatitis with refractory pancreatic strictures. The primary endpoints were technical success and procedure-related morbidity. Secondary endpoints were pain relief at the end of follow-up and resolution of the dominant pancreatic stricture at endoscopic retrograde pancreatography. Over 5 months, 10 patients with painful chronic pancreatitis and refractory dominant pancreatic duct strictures were treated with FC-SEMSs. All FC-SEMSs were successfully released and removed, although two stents were embedded in the MPD at their distal end and treated endoscopically without complications. Mild abdominal pain was noted in three patients after stent release. During treatment, pain relief was achieved in nine patients, but one continued to take morphine, because of addiction. Cholestasis developed in two patients and was treated endoscopically; no patient developed acute pancreatitis or pancreatic sepsis. After stent removal, the diameter of the narrowest MPD stricture had increased significantly from 3.5 mm to 5.8 mm. Patients were followed up for a mean of 19.8 months: two patients who continued drinking alcohol presented with mild acute pancreatitis; one patient developed further chronic pancreatic pain; and one had a transient pain episode. At the end of the study, nine patients no longer had chronic pain and no patients had required surgery. Endoscopic treatment of refractory MPD stricture in chronic pancreatitis by placement of an FC-SEMS appears feasible, safe, and potentially effective.

Dr. Ravindra B.S
Consultant Gastroenterology Hepatology Therapeutic Endoscopy