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Name -Dr. Kunal DasQualifications
M.D. (Medicine), D.M. (Gastroenterology)
Areas of Expertise
Gastroenterology, Hepatology, Endoscopy, Onco-Gastroenterology
Present Attachments
Max Super Speciality Hospital, Patparganj, New DelhiKailash Hospital, NoidaPrevious Experience
GB Pant Hospital (Senior Resident(DM) 2/05/2003 to 31/08/06)Sir Ganga Ram Hospital (Jr. Consultant From-Sept 2006)Kinki University-School of Medicine, Osaka, Japan (Fellowship Trainee June 2007–Dec 2007)Fortis Hospital, Noida (Consultant Jan 2008-Jul 2009)Professional Competencies (Relevant field)
Elective and emergency management of GI and Liver diseasesElective and emergency-Diagnostic and Therapeutic Endoscopies, Colonoscopies, and ERCPPalliative management of GI cancersEndoscopic UltrasoundOrganisation of CME's, Seminars with public, graduates, post-graduates and Gastroenterolgists, Medical camps etcDuties, Activities and Responsibilities as a Clinical Relevant Department
Managing regular OPD's and emergenciesDiagnostic and therapeutic endoscopic proceduresOrganising seinars, CME's etcDoing original research on H.pylori and GERDContinuing Professional Development
American College of Gastroenterology (ACG)Indian Society of Gastroenterology (ISG)Society of Gastrointestinal Endoscopy of India (SGEI)Association of Physicians of India (API)Indian Federation of Ultrasound in Medicine and Biology (IFUMB).
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Upper Gi Endoscopy Or Esophago Gastroduodenoscopy
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An upper GI endoscopy looks at the upper part of the gastrointestinal tract including the esophagus, the stomach and the first part of the small intestine, called the duodenum. The esophagus is a hollow tube that carries the food to the stomach and small intestine for digestion.
The gastroenterologist uses an endoscope, a long, thin, flexible tube with a light and camera at the end to help guide the scope throughout the duration of the procedure. The camera on the end helps the physician both guide the endoscope throughout the length of the upper GI tract, and take pictures.
Gastroenterologists commonly perform this procedure as a way to evaluate and diagnose various problems, such as chronic heartburn (acid reflux), difficulty swallowing, stomach or abdominal pain, bleeding, ulcers and tumors.
The patient remains comfortable during the procedure with the help of local and/or intravenous sedation. The drug enables the patient to remain awake and comfortable throughout the procedure.

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Endoscopic Variceal Ligation (evl)
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Endoscopic Variceal Ligation (EVL) is a procedure in which an enlarged vein or a varix (the plural is varices) in the esophagus is tied off or ligated by a rubber band delivered via an endoscope. It is also called rubber band ligation.
Esophageal varices develop as a complication of a sustained increase in blood pressure in the liver (portal hypertension), most commonly found in cirrhosis. The major problem with Esophageal Varices is the risk of bleeding.
EVL is used control or stop bleeding or to prevent re-bleeding. The success of the procedure is in the range of 90%. The procedure is performed as in regular EGD. An accompanying device is inserted into the endoscope channel which allows the delivery of ligating rubber bands to the engorged varix. Number of banding depends on the varices seen and may average 4-6.
Complications associated with EVL include additional bleeding due to tearing additional varices, ulceration of the lining over the varices, perforation or tear of the esophagus and aspiration of blood or gastric juice into the lungs.

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Endoscopic Sclerotherapy (EST)
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Sclerotherapy for esophageal varices involves injecting a strong and irritating solution (a sclerosant) into the veins and/or the area beside the distended vein. Sclerosant injected directly into the vein causes blood clots to form and stops the bleeding, while sclerosant injected into the area beside the distended vein stops the bleeding by thickening and swelling the vein to compress the blood vessel.
Sclerotherapy for esophageal varices is performed with the patient awake but sedated. During the procedure, an endoscope is passed through the patient's mouth to the esophagus to allow the surgeon to view the inside. The branches of the blood vessels at or just above where the stomach and esophagus come together, the usual site of variceal bleeding, are located.
After the bleeding vein is identified, a long, flexible sclerotherapy needle is passed through the endoscope. When the tip of the needle's sheath is in place, the needle is advanced, and the sclerosant is injected into the vein or the surrounding area. The most commonly used sclerosants are ethanolamine and sodium tetradecyl sulfate. The needle is withdrawn. The procedure is repeated as many times as necessary to eradicate all distended veins.

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Glue Injection in Gastric Varices
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Gastric varices are enlarged veins found in the stomach. They also occur in portal hypertension. . While gastric varices bleed less frequently than esophageal varices, the severity of bleeding and associated mortality is greater. Cyanoacrylate glue is a liquid substance with the consistency of water that transforms into a solid state when added to a physiological medium such as blood. When instilled into a varix using the standard method of intravariceal injection, the glue undergoes an instantaneous polymerization reaction and hardens to a rock hard substance, thereby plugging the lumen of the varix. This enables rapid hemostasis of active bleeding and prevents rebleeding.
A therapeutic gastroscope with a large working channel is used for injection. Variceal injection is performed with a 23-gauge disposable sclerotherapy needle. The varix is punctured under direct visualization and approximately 1cc of the glue is injected intravariceally. After injection, the patency of the varix is assessed with blunt catheter palpation and additional glue injected until the varices are obliterated.
Numerous studies from around the world with over 1,000 treated patients have reported control of active variceal bleeding in 93-100% of patients with rates of recurrent bleeding around 10%.
Cyanoacrylate compounds are routinely used in different medical and surgical subspecialties for embolization of aneurysms, arteriovenous malformations and fistulae, and as a wound or tissue adhesive. The safety profile of cyanoacrylate glue for varix obliteration is excellent. A minority of patients develop transient fever and pain after injection. There have been rare case reports of complications related to embolization, which include cerebral stroke and pulmonary embolism. Visceral fistulas have also been reported, probably due to misguided injections.

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Haemoclip Application in Gi Bleed
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  • Haemoclips are mechanical devices used to approximate two sides of a vessel to immediately, definitively, and securely occlude and arrest bleeding. On opening, the haemoclip is typically 11–12 mm wide from jaw to jaw.
  • Haemoclips are best deployed enface rather than tangentially. Haemoclip need to be placed at the correct angle and precise spot. Missing a target, even slightly, can render a haemoclip ineffective
  • At least two haemoclips are generally placed to clamp an actively bleeding artery in an ulcer. Haemoclips are relatively inefficacious for arteries that are larger than 2 mm wide. Haemoclips generally fall off 10–14 days after deployment—after the lesion has partly healed and when the lesion is unlikely to rebleed
  • The placement of these clips rarely produces complications other than failed efficacy. Haemoclips are less successful for the treatment of fibrotic lesions such as chronic ulcers
  • Hemoclips and thermocoagulation or electrocoagulations are equally efficacious in achieving long term haemostasis.

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Esophageal Dialatation
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Esophageal Dialatation

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An upper gastrointestinal (GI) endoscopy is a procedure to look at the inside of the oesophagus (gullet), stomach and duodenum using a flexible telescope. This procedure is sometimes known as a gastroscopy. A dilatation involves stretching the narrowed area. This is done either using ballon dilator, plastic graduated dilators (Gillard Savory dialators) or Bougie dilators.
If appropriate, the endoscopist may offer you to help you relax. An upper GI endoscopy usually takes about a quarter of an hour. The procedure involves placing a flexible telescope (endoscope) into the back of your throat. From here the endoscope will pass on into your duodenum. The endoscopist will be able to look for problems in these organs. They will be able to perform biopsies and take photographs to help make the diagnosis. The endoscopist can perform a dilatation using a guidewire and dilators or a balloon dilator.
Complications that can happen include Allergic reaction, Breathing difficulties or heart irregularities, Making a hole in the oesophagus, stomach or duodenum at the narrowing, damage to teeth or bridgework, Bleeding, Incomplete procedure etc.
If you were given intravenous sedation, you will normally recover in about an hour. A member of the team will tell you what was found during the endoscopy and will discuss with you any treatment or follow-up you need. You should be able to go back to work one to two days after the endoscopy. An upper GI endoscopy and dilatation is usually a safe and effective way of finding out if you have a problem with the upper part of your digestive system and treating your symptoms.

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Flexible Sigmoidoscopy
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Flexible Sigmoidoscopy

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"Sigmoidoscopy" is a procedure that allows the physician to examine the inside of the sigmoid colon. The colon, also known as the large bowel, is the last portion of your gastrointestinal tract. The sigmoid is the section of the colon closest to the rectum and anus. The colon, a hollow tube, measures four feet in length, 20 inches of which is the sigmoid colon. The function of the sigmoid colon, like the remainder of the colon is to store food byproducts until its elimination.
A colonoscope is used to perform this procedure. A colonoscope is a long, thin, flexible tube with a miniature video camera and light at its end. The gastroenterologist will infuse a little bit of air into the colon as he or she inserts the scope. The camera on the end helps the physician both guide the colonoscope throughout the length of the sigmoid colon and take pictures of the colon.
Flexible sigmoidoscopies are most commonly performed to evaluate problems such as blood loss, pain and changes in bowel habits. The patient will remain awake throughout the procedure. The patient may elect to watch the procedure on a television monitor above the bed. Air introduced to the colon during the procedure, may cause feelings of fullness and cramping, but acute pain is very rare. The procedure normally takes 10-15 minutes. Afterwards, the patient may drive home and resume normal activities.

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Polypectomy
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Polypectomy

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The removal of a polyp is called a polypectomy and can be achieved by using a variety of instruments through channels of the endoscope.
If a polyp is found on the left side of your bowel, there is a higher chance of you having polyps on the right side of your bowel. As a flexible sigmoidoscopy does not reach the right side of your bowel, you may be asked to return on another day for a full colonoscopy, if a polyp is found. A colonoscopy allows the entire large bowel to be examined and any further polyps to be removed.

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