Consultants:
Medical Gastro Enterology
Dr.D Jayakumar. MD, DM(Gastro).
PH NO: 9847430440
Dr.Rakesh. MD(Gen. Med),DNB(MED), DM(GASTRO)
Surgical Gastro Enterology
Dr.Antoine Berty. MS, DNB ,MCH DNB
The hepatology and gastro enterology department of NIMS Medicity is equipped with advanced diagnostic and therapeutic equipments for management of various GI & liver disorders.

 The equipments available are

·         Pentax  i-series advanced video endoscopy for upper GI, lower GI and ERCP procedures.

·         APC- Argon plasma coagulation with ERBE cautery for management of ulcer bleed and gastropathy and vascular ectasias.

·         Various foreign body removal accessories .

·         Various dilators for stricture dilatation including pneumatic dilator for Achalasia cardia , Hemoclip for ulcer bleed, facilities for benign and malignant strictures.

·         pH metry for esophagal reflux ,Hydrogen breath test for lactose intolerance and small bowel bacterial overgrowth.

·         Urea breath test to confirm H- pylori eradication.

·         Capsule endoscopy for small bowel.

  • PEG ( Percutaneous Endoscopic Gastrostomy) for longterm enteral feeding.

NIMS Medicity now in the only institution to install fibroscan machine in kerala to evaluate precirrhotic fibrosis. This machine is of immense value for assessing fibrosis without invasive liver biopsy. As we all know, once cirrhosis is established, it is irreversible –hence it is very important to diagnose and prevent development of cirrhosis at precirrhosis stage.

Endoscopic Procedures:

   • Endoscopic Sclerotherapy
   • Endoscopic Vericeal Band Ligation
   • Endoscopic Vericeal Glue Injection
   • Foreign Body Removal
   • Esophageal Stricture Dilatation
   • Pneumatic Dilatation for Achalsia
   • SEM (Self Expanding Metalic) Stending
   • Ca esophagus
   • Enteral Slenting
   • Polypectomy
   • Argon Plasma Co-ogulation
   • Percutanious Endoscopic Gastrostemy (PEG)
   • ERCP – Biliary & Pancriatic Slenting, Biliary Stone Removal, Sphincetrotomy, Biliary SEM
   • Endoscopic Cystogastrostomy





From Doctor's Desk
 
Dr. Jayakumar MD DM (Gastro)
 Consultant Gastroenterologist
 NIMS Medicity, Aralumoodu,
 Neyyatinkara, Trivandrum,
Kerala, India
FIBROSCAN
 The simple, noninvasive method to assess liver fibrosis preceding cirrhosis
 
 

 

         Cirrhosis liver is the end result of chronic insult to the liver, at which stage it is irreversible. A patient with cirrhosis carries the risk of developing ascites which may become refractory or may develop spontaneous bacterial peritonitis, which can be recurrent. He or she also can develop varices with resultant variceal bleeding. Hepatic encephalopathy is another long term consequence. A significant proportion of people will ultimately develop hepatocellular carcinoma. Hepatocellular carcinoma is asymptomatic in early stages.

            The causes of cirrhosis are varied. The majority of causes result from long term alcohol consumption and chronic viral hepatitis due to hepatitis B and C viruses. An increasing proportion of patients now develop cirrhosis liver due to fatty liver with associated steato-hepatitis. Uncommon causes are metabolic conditions and auto immune hepatitis and Biliary cirrhosis which may be primary or secondary.



The process of cirrhosis development is a long term one. Persistent inflammation initiates early fibrosis which progresses in severity in proportion to severity and chronicity of inflammation. Early Fibrosis is reversible; its inflammation process can be arrested where as cirrhosis is irreversible. Hence it become paramount to assess inflammation (grade) and fibrosis (stage) in chronic liver disease to plan management strategies to arrest further progression.

Liver biopsy is considered the gold standard for assessment of inflammation and fibrosis. However, it is an invasive procedure associated with risk of considerable morbidity and cost. There is a sampling error of 25-40% with poor reproducibility. There is inter observer variability of up to 20% in disease staging and 33% difference in grading with simultaneous right and left lobe biopsies. Fibrosis staging tends to be underestimated in the small biopsy sample made available through biopsy.

            There are now newer non invasive methods available to assess liver fibrosis. Serologic methods are not fully validated and not routinely available. Fibroscan (transient elastography) is a noninvasive method of liver fibrosis assessment with application of a probe over the hepatic area, similar to the ultrasound sonography. It assesses an area of more than 100 times the volume of tissue taken in liver biopsy. It measures the stiffness of liver which varies depending on the stage of fibrosis. The result is given as a numerical reading and is reproducible. The numerical value changes according to the grading/ stiffness of liver. The method is now accepted as a simple, non invasive quick and easy way to assess liver fibrosis which produces changes in stiffness of liver. It is not widely available in our country and at present less than ten institutions in our country only have this equipment. The availability of Fibroscan will increase in due course.

            Cirrhosis liver is increasingly diagnosed in advanced stage. The outcome of conservative management in advanced state is poor and its financial and social implication is enormous. Liver transplant is the only definitive treatment. It appears imperative to detect progressing fibrosis of liver at an early stage. It will certainly help clinicians to initiate or modify management and also can help forewarn patients about the need to quit alcoholism. The ultimate goal is prevention of cirrhosis. Preventive hepatology is the need of hour in hepatology practice in Kerala.

                                                                                  

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DR. JAYAKUMAAR-MEDICAL GASTRO ENTROLOGIST- TOPIC- HEPETITIS-B

    
DR. JAYAKUMAAR-MEDICAL GASTRO ENTROLOGIST- TOPIC- HEPETITIS-B- PART-1 DR. JAYAKUMAR-MEDICAL GASTRO ENTROLOGIST- TOPIC- HEPETITIS-B- PART-2