::Departments : Super Specialities : Medical Gastroenterology
A. Introduction to the Department

                         

Introduction to the Department:
A preamble (October 1986 – Dec 2011)
Oct 1986:        Department of Medical Gastroenterology: Started by Prof. KR Palanisamy
1987:               Sanction of posts of Asst Prof, staff nurses, typist
1988:               Sanction of 30 beds. 
                        Introduction of endoscopy services
                        First video endoscopy Unit installed
1996:               Introduction of DM post graduation:  2 candidates
1998:               Second videoendoscopy Unit (gastroscopy, colonoscopy and duodenoscopy)
                       500 MA X-ray Units with C-Arm and Image Intensifier
                        Introduction of Therapeutic endoscopy services
2000:               MCI recognition for DM Gastroenterology (Letter dated 25/4/2000 Ref.no: 23(1)/99-Med/1509)
 
The department has since then made a steady progress in terms of
  1. Patient care
  2. Academic and
  3. Research activities.
The Head of the Department is ably assisted by Asst Prof of Gastoenterology namely           Dr. M. S. Revathy MD.,DM, Dr. R. Murali MD.,DM,Dr. S.Chitra, MD.,DM., and Dr.M.Manimaran, MD.,DM., and six post graduates.
   The department is located in the ground floor and provides inpatient, outpatient and   
   endoscopy services and works in unison with the surgical Gastroenterology department..
 
 
 
 
 
 
Common to both the departments (MGE and SGE) are:
 
i.                    A 6 bedded ICU for management of critically ill patients
ii.                  Radiology department headed by Dr. Sukumar for diagnostic and interventional radiological procedures.
iii.                Laboratory facilities for basic hematological, hepatology and renal evaluation.
iv.                Microbiology lab for blood culture, virology for Hepatitis B, Hepatitis C etc.
v.                  Individual/shared rooms for patients in the I, II and IIIrd floor of the GE block (under TNMSC scheme).
vi.                A seminar room with a seating capacity of 60, withstate of the art facilities for audio and video screening and 24 hour online access to international journals.
 

 
 
 
 
 
 
 
 
 
 
 
The department provides the following facilities for patients and postgraduates:
 
1.      PATIENT CARE:  OP and IP services
 
2.      ENDOSOCPY SERVICES:  Diagnostic and Therapeutic
 
3.      PG TRAINING
a.      Academics:  CME/ Endoscopy workshop/HBV Awareness Programs
b.      Research Activities
c.       Participation in Regional and National Congress of the Indian Society of Gastroenterology
 
1.    PATIENT CARE
a) Out patient services
The Department runs an OP clinic on five days a week – Monday to Friday. New and old cases are seen on all days (average of 20 new cases and 56 old cases) .Emergency cases are seen at any time on all days.  Patients with gastrointestinal and liver diseases are referred to this department by all medical, surgical and specialty departments of this hospital, other Governmental institutions including Institute of Child Health, other quasi Government and private institutions from northern part of Chennai city and private practitioners. Patients from distant places – within Tamil Nadu state and outside the State are also referred and managed here. A steady increase in the number of cases has been seen over the years.
 
SPECIAL CLINICS
The Liver Clinic
A significant proportion of outpatients suffer from liver disease (almost one third).  A liver clinic was introduced in August 2001, with an intention to provide additional care for these patients and to get them introduced to a transplant protocol, if and when possible.  The clinic is conducted on Mondays through to Friday.  On an average 50 cases are seen per day (New cases - average:  10 per week) (Fig 1).  Two- thirds of the cirrhotic patients have hepatitis B, alcohol related or a combination of other risk factors.  Variceal
bleed, peritoneal infection, hepatic encephalopathy and hepatoma are the common causes of morbidity and mortality.
           
 

Liver transplant Clinic:
Monday : Cases listed  for liver transplant
Tuesday : Patients with HBV and HCV infection
Wednesday: Ethanol related liver disease, patients with surgical contraindications
Thursday:  Noncirrhotic portal hypertension, Budd Chiari syndrome,Wilsons disease
Friday : Delisted cases (not willing for liver transplant): 
The department is actively involved in the liver transplant programme. Patients selected on Monday are counseled by the transplant co-ordinators.  Till date 269 patients have been registered and categorised based on blood group.  The finalisation of the list is done on Saturday between 8 and 9 AM at the board meeting. The department works in co-ordination with the department of cardiology, surgical gastroenterology and anesthesiology.  Till date counselling has been done for 95 cases and 26 cases are given high priority and have been listed for transplant (NON B NON C, Non Alcoholic), totally 25 patients are registered in Tamil Nadu Organ Sharing Network.
The Liver tranplant Board meet is constituted by Dr Jeswant (Surgeon), Dr, A.R.Venkateswaran (Gastroenterologist), Dr. Sukumar (Radiologist), Dr. Rosy (Microbiologist), Dr Deepti (Anesthesist), and senior registrars:  Dr Sivasubramanian, Dr. Arul Selvam, Dr.Harri Prasad and Dr. Preethi
 
                Table:  Total no. of patients listed for transplantation
Listed patients
 
A
 
3
B
 
7
AB
 
1
O
 
9
TOTAL
 
20
 
Central registration is done with Dr. J.Amalorpavanathan, Convenor, Transplant Coordination Program at Madras Medical College, Chennai. Delisted cases are being encouraged and counseled to undergo liver transplant.
The liver transplant surgical programme which took off with a great start in January 2009 has been running regularly  with a total of 33 cases till date, with 10 surviving patients who are on regular follow up.
 
The Pancreatic Clinic
A significant proportion of patients suffer from acute and chronic pancreatitis often alcohol related or secondary to calcification in the pancreatic duct.  The clinic was introduced in April 2005 and is conducted on Tuesdays.  The details of the cases are recorded on to a pre-structured proforma and registry is maintained.  The center contributes to the disease burden as a Core Member to the parent body at the national level (Ethics committee approval obtained).   The results of the core meet have been puiblished in Pancreas 2008.  The project continues with modification of the proforma.
 
The Inflammatory Bowel Disease Clinic
On an average, 9 to 10 Cases with IBD are seen per week.  The clinic is conducted on Tuesdays.  Bleeding per rectum, malnutrition and other complications are common.  All patients are registered in the clinic and data is obtained in a pre-structured proforma. The center contributes to the disease burden as a Core Member to the parent body at the national level (Ethics committee approval obtained).Genetic studies are underway in collaboration with Christian Medical College Vellore.
 
Pediatric Care
 Children with GI disorders including liver disease (portal hypertension and Wilson’s disease) attend the department on Fridays.  Foreign body removal, endoscopic sclerotherapy services apart from routine UGI scopy and colonoscopy are offered to these children. 
 
 

 
OVERALL PREVALANCE OF COMMON PROVEN GI DISEASES IN OPD]
 
 
DISEASE PERCENTAGE
Endoscope positive GERD 3.8
Cancer Esophagus 1.5
Corrosive stricture Esophagus <1
UGI Bleed 7.5
Gastric ulcer/ Gastritis/ Gastric erosion 6.5
Cancer stomach <1
Ulcer Disease/ Erosions/ Duodenitis 10
Non Ulcer dyspepsia 23
Small Bowel Diarrhea <1
Tb GIT <1
Cancer Colon 1
Crohn’s disease <1
Ulcerative Colitis 2
Irritable Bowel Syndrome 1.6
Hemarrhoids/ Fissure 1.2
Viral hepatitis 1
Cirrhosis Liver 6.4
Budd Chiari <1
Wilson’s disease <0.5
EHPVO 1.3
Abscess liver <1
Acute Pancreatitis 2
Chronic Pancreatitis 5
Pseudocyst of pancreas <1
Cancer Pancreas <1
Obstructive Jaundice – Malignant <1
Gall Stone Disease 2.1
Obstructive jaundice – CBD stones 1.5
Miscellaneous 10
Hepatoma 1
HbsAg Carrier 1
 
 
 
 
 
 
 
b. Inpatient Services
The Department has 30 beds, (20 for males and 10 for females)
(G.O.Ms. No 2000 H dt. 22.10.87 – 10 beds),(G.O.Ms. No. 1251 H, dated 13.6.88 for additional beds communicated in DME’s letter No.108341 /P&DII/2/dt. 3.12.87 and 15.3.88 – 20 beds)
Besides the General ward, patients are admitted in the Intensive Medical Care as well as in the special wards.                              
 
 
 
 
 
 
                                                           
INPATIENT STATISTICS: DISEASE PATTERN
Disease Male Female Total
Dyspepsia 12 38 50
CA esophagus 12 20 32
CA stomach 8 6 14
GOO 14 6 20
Post OP stomach 15 9 24
Corrosive stricture 25 55 85
Cricopharyngeal web 12 48 60
GI bleed – nonvariceal 37 13 50
Diarrhea 23 27 50
IBS 8 12 20
IBD 23 33 56
TB 17 15 32
Ascites 9 16 25
Bleeding PR 17 8 25
DCLD 376 112 488
Budd chiari 6 10 16
EHPVO 28 30 58
NCPF 17 25 42
Acute hepatitis 10 12 22
Chronic hepatitis 14 16 30
HCC 8 4 12
Liver abscess 10 3 13
GSD 7 16 23
CBD stones 12 20 32
CA pancreas 7 1 8
Malignant biliary obstruction 27 9 36
Chronic pancreatitis 20 2 22
Acute pancreatitis 32 3 35
Miscellaneous 23 17 40
Total 1034 386 1420
       
 
 
 
 
 
 
 
                   PATIENT STATISTICS    - Outpatient & Inpatient
 
                                           Outpatient                              Inpatient
Year                             New                Old                                         
1986                             40                      36                                   -                 
1987                             942                  962                                   -                
1988                            1750              3166                                929              
1989                            3647              4056                              2228               
1990                            3623              4658                              2080               
1991                            4160              6693                              2050               
1992                            5376              9953                              3589               
1993                            6468            12083                              4346               
1994                            5857            10863                              3286               
1995                            4879              7189                              2666               
1996                            5160              6836                              2725               
1997                            6115            7856                               3094
1998                            6029              5801                              2798               
1999                            5922              6001                              2810               
2000                            5287              5042                              2715               
2001                            6488              6291                              3158
2002                            6796              9370                              4364               
2003                            6935            10200                              5217
2004                            6537            13790                              5617
2005                            5924            16709                              1475
2006                            5948            16507                              1372
2007                            7066            21289                              1463
2008                            6420            21564                              1234                                                      
2009                            6691            19950                               1368
2010                            8105           20435                                1420
2011                           7413             24338                              1544
2012                           3237             6634                                 
        
                               
Causes of mortality
 
  Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Total
Variceal Bleed 0 0 0 0 1 1 0 0 1 0 2 0 5
HRS 0 1 0 2 0 0 1 0 1 1 0 0 6
Hepatic Encephalopathy 0 0 0 1 2 1 2 1 1 0 0 1 9
Multifactorial 0 0 0 0 1 0 0 1 0 0 1 1 4
Malignancy 0 0 0 0 1 0 0 0 1 0 1 0 3
Total 0 1 0 3 4 2 3 2 4 1 4 2 30
 
         

 
 
 
C.  Special Investigation Facilities
    
   i. Endoscopy Facilities
 
All diagnostic endoscopic procedures like gastroscopy, colonoscopy, proctosigmoidoscopy and therapoeutic procedures like ERCP etc. are undertaken routinely on all days of the week (including emergency) except on Sundays. The major work load is on diagnosis and therapeutic procedures for variceal bleed, ulcer bleed, corrosive stricture, foreign body retrieval and polypectomy.
Most of the endoscopes purchased at the time of inception of the department have been condemned. The scopes (PENTAX) purchased in 1998 have also undergone several repairs due to the excess wear and tear.  Most of the work now is being done with the fibreoptic scopes purchased in 2001-2002, through the office of Dean.  The department expresses its thanks to the Govt. of Tamil Nadu (TNMSC) for enabling us to acquire the most updated videoendoscopic unit utilizing the FICE technology for a sum of Rs 49.5 lakhs in 2008.
 
 
 
 
 
Regular therapeutic procedures include
Endoscopy Sclerotherapy
Endoscopic variceal Ligation
Dilatation of Oesophageal strictures & Achalasia Cardia
Foreign body removal.
Polypectomy (UGI and LGI)
Therapeutic ERCP
Details of Endoscopy procedures till date
Upper GI Procedures
 
                   OGD      EST      Glue    EVL    polyp     Dilatation     FB removal                         
1986-90        nil           nil        nil        nil        nil             nil               nil                                    
1987             nil           nil        nil        nil        nil              nil              nil               
1988             422         nil        nil        nil        nil              nil              nil               
1989             2680       26        nil        nil        14              nil              nil               
1990             2508       12        nil        nil        4                17                3               
1991             3165       16        2          nil        12              20              nil               
1992             4189       30        nil        nil        20              87                1               
1993             4985       nil        2          nil        16              81              nil               
1994             4458       24        2          nil        11              39              nil               
1995             3750       31        nil        3          4                37              2                
1996             3686       48        1          1          nil              37              3                
1997             5289       53        nil        nil        nil              58              5                
1998             4233       66        nil        nil        nil            132              6                
1999             4102       116      nil        nil        nil            181              9                
2000             4159       72       nil        6            7            157              5                
2001             3724       101      nil        1            5            110               2                 
2002             3211       69        nil        nil          5              88              1                 
2003             3460      125       nil         5           3            116               2                 
2004             4052      157       nil         3           1            112               1                 
2005             3634      336       nil        10        nil             92                2                 
2006             4004      343      nil         24        nil             47                nil               
2007             3360      195      nil         70          1             14                nil               
2008             2995      98        5            75         2              45               2
2009             5300      39        1             91         7             59              nil
2010             3495       27        7           143        1            52               nil
2011            3601        28       3            139        1            60               1
2012           1051       4         nil            23         nil           14               1
 
ANALYSIS OF UGI ENDOSCOPY (2011 )  
 
No: of UGI endoscopies:                                                    3601      
                                                 
 
Normal:                                                                                 1021                      
 
Esophagus:
           1. Oesophagitis (GERD, erosion, distal                      185                  
                                                   Oesophagitis)                                 
           2. Varices                                                                    599                      
           3. Carcinoma                                                                 52                  
           4. CP web/Stricture/Achalasia cardia                           64                                      
           5. Lax LES/Hiatus Hernia                                           339                    
           6. Ulcer                                                                         23       
              
Stomach:
           1. Gastric ulcer :( Gastritis, erosions)                        595                    
           2. Carcinoma                                                                56                         
           3.  Varices                                                                    40                   
           4.  Congestive gastropathy                                           36                      
           5.  Gastric outlet obstruction                                        18            
        
Duodenum:
           1. Duodenal ulcer (duodenitis)                                     181                 
           2. Duodenal carcinoma                                                    4     
 
              
Miscellaneous                                                                         390                      
 
 
Colonoscopy
                                             Diagnostic                                  Polypectomy
1988                                           5                                                 nil
1989                                         127                                               nil
1990                                         84                                                 nil
1991                                         120                                                3
1992                                         117                                                3
1993                                         146                                                6                                               
1994                                         195                                                11
1995                                         221                                                 5
1996                                         223                                                 8
1997                                         265                                                 -  
1998                                         294                                                 -
1999                                         335                                                 -
2000                                         315                                                 -
2001                                         236                                                 4
2002                                         285                                                 5
2003                                         231                                                 2
2004                                         255                                                 nil
2005                                         291                                                 nil
2006                                         206                                                 nil                    
2007                                         219                                                 nil
2008                                         254                                                  2
2009                                         283                                                  9
2010                                         339                                                 nil
2011                                        555                                                 3
2012                                       168                                                 nil
 
 
 
 
Sigmoidoscopy
 
 
 
Year                                   Flexible Sigmoidoscopy               Rigid
1986                                        nil                                            -
1987                                        nil                                            -
1988                                        2                                              -
1989                                        63                                             -
1990                                        139                                           -
1991                                        244                                           -
1992                                        290                                           -
1993                                        224                                          -
1994                                        351                                          -
1995                                        236                                           -
1996                                        184                                           -
1997                                        201                                           -
1998                                        157                                          39
1999                                        194                                          31
2000                                        212                                          35
2001                                        226                                        152
2002                                        184                                          60
2003                                        163                                          28
2004                                        276                                          24
2005                                        198                                          18
2006                                                                                          6
2007                                      132                                       Not functioning   
2008                                       241                                      condemned
2009                                       246  
2010                                       291                                  
2011                                       141
2012                                        22
ii. DIAGNOSIS AT COLONOSCOPY (2011)
 
Total number:                                                                 555 
Normal                                                                              256
Polyp                                                                                  35    
Carcinoma                                                                          42     
IBD: UC                                                                             27  
Crohns’ disease/TB                                                            12      
Non specific ulcers                                                            35      
Haemorhoids, fissures, fistulas, rectal varies                    65 
Diverticula                                                                         05       
Miscellaneous                                                                    74
SRU:                                                                                  04       
 
 
 
iii. DIAGNOSIS AT SIGMOIDOSCOPY (2011)
 
Total                                                                                  141
Normal                                                                                 34           Hemorrhoids/fissure/fistula/prolapse                                   38      
Anal/rectal growth                                                               15             
Proctitis                                                                                06          
Polyp                                                                                    20         
Rectal varies                                                                         00          
Miscellaneous                                                                      24     
Stricture                                                                               00          
Rectal ulcer                                                                          04          
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
         ERCP statistics
 
                                        Diagnostic     Sphincterotomy                 Stent
1986                                          nil                  nil                                nil
1987                                          nil                  nil                                nil
1988                                          nil                  nil                                nil
1989                                          nil                  nil                                nil
1990                                          11                  nil                                -
1991                                          59                    3                                3
1992                                          68                    5                                1
1993                                          70                    1                                1
1994                                          96                  10                               nil
1995                                        122                    8                               nil
1996                                         63                    4                               nil
1997                                        185                  15                                8
1998                                        253                  31                                6
1999                                        241                  58                              24         
2000                                        189                  24                              24
2001                                           9                   nil                              nil
2002*                                       68                   19                                8
2003*                                       97                     6                                6
2004*                                       84                   nil                              nil
2005                                         29                   nil                                 1
2006-7                                     54                   67                                 34
2008                                         84                110                                113           
2009                                         56                  99                                112
2010                                         44                  66                                  44
2011                                         81                  72                                 54
2012                                         11                 8                                   6
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Ultrasonography(Installed on 18-9-03)
              Year                   No. of USG           Doppler**      Therapeutic
                                                                                                abscess drainage        FNAC
 
2003                                    89                  123                              1                      2
2004                                   235                 228                              5                      24
2005            
2006            
2007                                   160
2008                                   136                310                              7                      36
2009                                   174                385                              9                      47
2010                                   180                424                              8                      36
 
Details of functioning/non functioning and condemned Instruments in the Department as on date:\
S. No. Item Functioning Condemned  
  Ultrasound scanner     Sonata Functioning (in use)    
  Pulse oximeter (Miti)EJ 5374 Functioning (in use)    
  Fibreoptic gastroscope (P) FG 29V Functioning    
  500 MA X-ray unit  Functioning    
  Cold light source(P)    LH-150 PII            Functioning    
  Colonofibrescope (P)  FC 38 LV                        Not functioning  Repair action taken  
  Colonofibrescope (P)  FC-38FP Not Functioning  Condemnation cert. Obtd  
  Video Colonoscope EC3830L Not functioning Condemned 23.1.08  
  Video Duodenoscope EC 3430T Not functioning To be condemned   
  Video endoscop system(Fuginon) Functioning Working
  Video monitor (P)       No scope  Not in use
  Xenon Light Source (P)                     
No functioning scope
 Not in use
  Video Processor (P)    EPM 330 P No functioning scope  Not in use
  Video Duodenoscope EC 3430T Not functioning To be condemned 
           
Postgraduate Training
Training
The postgraduates attend to the patients in the Outpatient services, provide inpatient care, and attend to calls from other wards on all days. The Head of the Department and assistant professors discuss the 'call over cases' the following day.  Daily sessions are held in a) Radiology b) Pathology.  Joint meetings with surgical gastroenterology include Journal club, Brain Storm sessions,topic discussions as well as faculty lectures on Saturdays.  The PG students are on 24 hr duty on all days and attend to ward patients and manage emergencies under the guidance of The Head of Department and Assistants who are available on call on all days. The students maintain a Logbook highlighting daily activities and procedures carried out during the posting, which is reviewed fortnightly.
 
i. Endoscopy Training:
Practical endoscopy training in imparted.  In the initial 6 months the new registrants are taught the basics of endoscopy, how to handle scopes, cleansing of scopes, the role of sedation etc.   They are made to observe various procedures using either the lecture scope or in the video (when working).  The candidates are taught the procedure during the next 6 months and are then made to carry out the procedure under supervision during the entire training period. Therapeutic procedures are taught in the second year - endoscopic sclerotherapy, balloon dilatation , stricture dilatation using Savary-Gillaird dilators. By the end of the training they would have performed over 100 gastroscopies, 50 colonoscopies, and at least 20 therapeutic procedures. 
 
ii. Academic sessions
Academic sessions take place regularly, during which the DM candidates as well as the faculty members participate actively.  Following is the teaching program:
 
1.      Bedside clinics                                                Daily
2.      Lectures by faculty                                         Once a week
3.      Ward rounds                                                   Daily
4.      Log book Maintenance                                   Daily
5.      Endoscopy Training (By rotation)      Daily                          
6.      Practical GI procedures                                  Daily
7.      Ward work (by rotation)                                 Daily
8.      Journal club                                         Once a week
9.      P.G. Seminar                                       Once a week
10.  P.G. Test                                                         Once a week
11.  Departmental Review meeting                       Once a week
12.  Liver transplant counseling                 Twice  weekly (Mondays)
13.  Liver transplant board meet                Monday          
14.  CME:  jointly with SGE                                 Once a month
15.  Conference Attendance                                  Compulsory
16.  (ISG/INASL/SGE/Endoscopic workshop)          
17.  Physicians meeting: Interesting cases are presented at the meeting. 
 
Model examination in theory is conducted every Thursday and clinics are taken on all days except Sundays. 

 

iii. Weekday Activities:  8 AM to 4 PM

 
1.      8.00 am – 9.00 am                   PG discussion            
2.      9 am- 10 am                Ward Rounds daily    
3.      From 9.30 am Mon-Fri            Out Patient
4.      12.30 – 2.00 pm (daily)           Case presentations                 
5.      Mon to Friday                         Liver clinic
6.      Tuesday                                   Pancreatic clinic, IBD clinic
7.      Tuesdays                                 Journal club
8.      Wednesday                 Physicians meet – CME Pictorial + Case presentation+Audit meet
9.      Wednesdays                Topic discussion
10.  Thursday                                 Brain storm; X-ray sessions’
11.  Saturday                                  Department Audit                  
12.  Third Saturday                        GE Gut Club
 
 
 
Brain storm cases
Some of the difficult to manage cases were discussed in the combined surgical-medical GE meet. Some of the interesting cases were
1)Amritham, 40, F, a case of ascites due toprimary peritoneal pathology
2)Thirumal, 45, M, a case of OG  junction tumour
3)Shanmugham, 50, M, a case of hepatolithiasis and cholelithiasis and CBD stones
4)Sumithra, 20, F, a case of eosinophilic gastroenteritis
5)Saravanan, 30, M a case of PUO with splenomegaly
6)Sundaram, 48, M , a case of cholelithiasis with cholecystostomy and sequlae
 
Journals
 
All the DM postgraduates present journals from peer reviewed publications every week on Tuesdays. Some of the journals presented were
1)Clinical Predictors of Fibrosis in Patients with Chronic Liver Disease - M. Stepanova et al Alimentary Pharmacology & Therapeutics June 2010
Center for Liver Diseases at Inova Fairfax Hospital, Falls Church, VA, USA
2) Effect of the BioEnterics intragastric balloon on weight, insulin resistance, and liver steatosis in obese patients- Gastrointestinal Endoscopy - Volume 71, Issue 6 (May 2010) Rosario Forlano, MD
3)Covered versus uncovered self-expandable metallic stents for palliation of malignant pyloric obstruction in gastric cancer patients: A randomized, prospective study-Center for Gastric Cancer, National Cancer Center,Goyang, Korea GASTROINTESTINAL ENDOSCOPY  July, 2010
4) Predictors of nonresponse to lactulose in patients with cirrhosis and hepatic encephalopathy -Praveen Sharma et al,G.B.Pant Hospital, New Delhi.-European Journal of Gastroenterology & Hepatology 2010, 22:526–531
5) Rifaximin Treatment in Hepatic Encephalopathy - Nathan M. Bass et al-  The  New England Journal  of  Medicine,  March 25, 2010
6) immediate listing for liver transplant versus standard care for Child Pugh B stage B alcoholic cirrhosis Claire Vanlemmens, MD; Vincent Di Martino, et al. & TRANSCIAL Study Group .Ann Intern Med. 2009;150:153-161
7) Telapravir for previously treated chronic HCV infection NEJM April 8, 2010
John G. McHutchison, M.D et al
8) Ef???cacy and safety of single-session argon plasma coagulation in the management of chronic radiation proctitis  Author Michael P. Swan et al center Melbourne, Victoria, Australia Published   Gastrointestinal endoscopy,  July 2010
Standard triple ,bismuth pectin quadruple and sequential  therapies for Helicobacter pylori eradication Xiao-Zhong Gao et al, Division of Gastroenterology, Weihai,china
World J Gastroenterology ,september 2010
9) Recurrence after endoscopic piecemeal mucosal resection for large sessile colorectal polyps. Guh Jung Seo, Dae Kyung Sohn, Kyung Su Han, Chang Won Hong, Byung Chang Kim, Ji Won Park, World J Gastroenterol 2010 June 14; 16(22): 2806-2811
  10)  EUS-Guided Cholecystoenterostomy With Single-step Placement Of A 7F Double-pigtail Plastic Stent In Patients Who Are Unsuitable For Cholecystectomy: A Pilot Study
 Tae Jun Song et al  Division of Gastroenterology, Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center,  Seoul, South Korea
    GASTROINTESTINAL ENDOSCOPY    Volume 71, No. 3  :Mar  2010
11)Duration of the interval between the completion of bowel preparation and the start of colonoscopy predicts bowel preparation quality Ali A. Siddiqui, MD, Kenneth Yang, MD, Stuart J.   Spechler, MD, Byron Cryer, MD, Raquel Davila, MD,Daisha Cipher, PhD, William V. Harford, MD Dallas Veteran’s Affairs Medical Center, Texas, USA
Gastrointestinal endoscopy volume 69, pages 700-706, March 2009
12)A new index for non-invasive assessment of liver fibrosis
Naohiro Ichino, Keisuke Osakabe, Toru Nishikawa, Hiroko Sugiyama, Miho Kato, Shiho Kitahara, Senju Hashimoto, Naoto Kawabe, Masao Harata, Yoshifumi Nitta, Michihito Murao, Takuji Nakano,Yuko Arima, Hiroaki Shimazaki, Koji Suzuki, Kentaro Yoshioka
World J Gastroenterol 2010 October 14; 16(38): 4809-4816
13) Endoscopic therapy of small-bowel polyps by double-balloon enteroscopy in patients with Peutz-Jeghers syndromeHong Gao & Margot G. van Lier et al
    Journal of Gastrointestinal Endoscopy  April  2010
14) Endoscopic sphincterotomy combined with large balloon dilation can reduce the procedure time and fluoroscopy time for removal of large bile duct stones                          Takao   Itoi T et al   Department of Gastroenterology and Hepatology, Tokyo Medical University Hospital, Japan.    Am J Gastroenterology - 01-MAR-2009; 104(3): 560-5
•       Safety and ef???cacy of endoscopic spray cryotherapy for Barrett’s esophagus with high-grade dysplasiaNicholas J. Shaheen et  alMulticenter study Journal of gastrointestinal endoscopy April 2010
 
15) Simple non-invasive fibrosis scoring systems can reliably exclude advanced fibrosis in patients with non-alcoholic fatty liver disease GUT  September 2010, volume 59, issue 9 Stuart McPherson et al
16) High-Dose Ursodeoxycholic Acid Therapy for Nonalcoholic Steatohepatitis: A Double-Blind, Randomized, Placebo-Controlled Trial    Ulrich F. H. Leuschner et al
  Journal of Hepatology , April 2010Centre- Germany
17) Covered versus uncovered self-expandable metallic stents for palliation of malignant pyloric obstruction in gastric cancer patients: A randomized, prospective study  Center for Gastric Cancer, National Cancer Center,Goyang, Korea.GASTROINTESTINAL ENDOSCOPY  July, 2010
18) Biliary stenting in the management of large or multiple common bile duct stones
Horiuchi et al,Matsumoto, Japan ; Houston, Texas, USA GASTROINTESTINAL ENDOSCOPY  ,june 2010
19)Efficacy and safety of biodegradable stents for refractory benign esophageal strictures: the BEST (Biodegradable Esophageal Stent) study Alessandro Repici et al, Utrecht, The Netherlands GI Endoscopy ,november,2010
20)Standard triple ,bismuth pectin quadruple and sequential  therapies for Helicobacter pylori eradication Xiao-Zhong Gao et al, Division of Gastroenterology, Weihai,china
World J Gastroenterology ,september 2010
21)Biliary stenting in the management of large or multiple common bile duct stones
Horiuchi et al, Matsumoto, Japan ; Houston, Texas, USA GASTROINTESTINAL ENDOSCOPY  ,june 2010
22)Usefulness of non-invasive markers for predicting liver cirrhosis in patients with chronic hepatitis B Kwang Gyun Lee et al, Korea university college of medicine,Seoul,Korea Journal of Gastroenterology &Hepatology ,May 2009
23)High serum creatinine in acute pancreatitis.A Marker for Pancreatic Necrosis?
Lankisch PG et al,Luneburg,Germany American journal of gastroenterology ,JULY 2010
24)Efficacy and safety of biodegradable stents for refractory benign esophageal strictures: the BEST (Biodegradable Esophageal Stent) study Alessandro Repici et al, Utrecht, The Netherlands GI Endoscopy ,november,2010
25)Effectiveness of Warm Water Consumption to Reduce Patient  Discomfort During Colonoscopy:A Randomized Controlled Trial Hyuk Lee et al,Dept.of Medicine,
Samsung medical centre,Seoul The AJ of GASTROENTEROLOGY December,2009
18)Capsule Endoscopy versus Colonoscopy for the Detection of Polyps and Cancer. EJM July 16, 2009.
20)Radiofrequency Ablation in Barrett’s Esophagus with Dysplasia. N Engl J Med 2009
21)Intravenous Esomeprazole for prevention of recurrent peptic ulcer bleeding. Ann Intern Med. 2009
22) A randomized, controlled comparison of warm water infusion in lieu of air  
        sufflation versus air insufflation for aiding colonoscopy insertion in sedated patients
        undergoing colorectal cancer screening and surveillance   Joseph W. Leung, MD, et   
        al. Los Angeles, California, USA
  23) Usefulness of Endoscopic Ultrasonography in Determining the Depth of Invasion  
        and Indication for Endoscopic Treatment of Early Gastric Cancer   Ritsuo Mouri,  
       MD, Shigeto Yoshida, MD, PhD et al J Clin Gastroenterol 2009.
  24) Endoscopic treatment of proximally migrated pancreatic duct stents Leslie H. Price,
        MD et al Seattle, Washington, USA GI endoscopy July 2009
  25) The Water Immersion Technique is Easy to Learn for Routine Use during EGD for  
        Duodenal Villous Evaluation A Single-Center 2-year Experience Giovanni
        Cammarota, MD,* Paola Cesaro, MD,* J Clin Gastroenterol 2009
  26) The utility of a multibending endoscope for selective cannulation during ERCP in
        patients with a Billroth II gastrectomy Hyun Cheol Koo, MD et al Bucheon, Seoul,  
  27) A comparison of conventional endoscopy, chromoendoscopy,and the optimal-band
       imaging system for the differentiation of neoplastic and non-neoplastic colonic
       polyps   Kazutomo Togashi, MD, Hiroyuki Osawa, MD et al GI Endoscopy
  28) Endoscopic cyanoacrylate versus TIPS for Gastric variceal bleeding – A single 
        center analysis, Micholas J. Piocaccini et al, University of Virginia, USA Clinical
        endoscopy, March 2009.
 29) Modified percutaneous transhepatic variceal embolization with 2 – Octul 
       cyanoacrylate in the treratment of bleeding oesophageal varices. Chun Quig Zhang,
       MD et al. Department of Shandong, Provincial Hospital, Shandong, China, Journal
       of clinical Gastroenterology, May-June 2009.
 30) Association of Proton Pump Inhibitor with Spontaneous Bacterial Peritonitis in
       cirrhotic patients with Ascites, Dr. Jasmohan S Bajaj et al, McGuine VA medical
       centre, Virginia,  The American Journal of Gastroenterology, May 2009.
 31) CA 19 – 9 to differentiat Benign and Malignant masses in chronic pancreatitis , Is
       there any Benefit? Dr.H Ramesh et al, Amirtha Institute of medical Sciences,
       Cochin, India. Indian Journal of Gastroenterology, Feb 2009.
 32) Oesophageal capsule endoscopy versus endoscopy for the evaluvation of Portal
       Hypertension – A French prespective multicentre comparative study. M.g Lapulus,
       MD, et al Herriot, Lyon, France, Volume 104, The American Journal of 
       Gastroenterology, May 2006.
 33) Papillectomy for ampullary neoplasm : Results of a single referral centre over a 10
      year period. Shouyan Irani MD, et at, Seattle, USA Gastrointestinal endoscopy, Vol
      70, No.5, 2009.
34) Management of painful chronic pancreatitis with single dose radiotheraphy. Luisa
      Guarnea MD et al, The American Journal of Gastroenterology, January 2009.
 35) Hyponatremia is a risk factor of hepatic Encephalopathy in patients with cirrhosis. A
       prospective study with time dependent analysis. Monica Guevara et al, The
      American Journal of Gastroenterology, June 2009, Vol. 104.
 36) The role of mast cell stabilistion in treatment of post operative ilius : A pilot study.
       Frans O Jhe MD, et al, Department of GE & hepatology, Academix medical centre,
       Netherlands, The American Journal of Gastroenterology,  Vol 104, p2257 – 2266
       June 2009.
 37) Comparison of CT colonoscopy, colonoscoly, sigmoidoscopy and farcal occult blood
       test for the detection of  advanced adenoma in an average risk population. A Graserr,
       et al, GUT 2009.
 38) Combination treatment with Octreotide, Midodrine, and Albumin improves survival
        in patients with Type I & Type 2 Hepatorenal Syndrome. Catherine Skagen et al.
       University of Wisconsin, Madison, J Clin Gastroenterol August 2009.
39) Duration of the interval between the completion of bowel preparation and the start of
      colonoscopy predicts bowel preparation quality. Ali A.Siddiqui,MD, Dallas Veteran’s
      Affairs Medical Center, Texas, USA, Gastrointestinal endoscopy volume 69, pages
     700-706, March 2009.
40) EUS-FNA predicts 5-year survival in pancreatic endocrine tumors. Fatima
      A.F. Figueiredo, MD, PhD et al. Gastrointestinal Endoscopy - Volume 70, Issue 5
      (November 2009).
 41) Role of IGG anti-beta-lactoglobulin antibody in the diagnosis of cow’s milk protein
       intolerance in India. Ujjal Podda et al SGPGI, Ind. Journal of GE August 2009.
42) Incidence and risk fators of progression to cirrhosis in inactive carriers of Hepatitis B
      Virus. Chia-Ming Chu, MD and Yun-Fan Liaw, MD Liver Research Unit, Chang
     Gung Memorial Hospital, Chang Gung University College of  Medicine. The
     American J of Gastroenterology Vol 104, July 2009.
43)Acomparison of direct endoscopic necrosectomy with transmural
     endoscopic drainage for the treatment of walled-off pancreatic
     necrosis. Timothy B. Gardner, MD, Prabhleen Chahal, MBBS et al, Rochester, 
     Minnesota, USA, Clinical Endoscopy Sep 2009.
44) Factors associated with abdominal discomfort during colonoscopy: A prospective
      analysis. David A. Elphick, Mark T. Donnelly, Karen S. Smith and Stuart A. Riley  
       European Journal of Gastroenterology & Hepatology 2009,Vol 21:1076–1082.
 
 
Topic discussion
 
The DM postgraduates give a lecture on varied topics every Saturday morning. Some of the topics presentes were
 
  1.  Metastatic Neuroendocrine Tumors: Current and Future Medical Therapies.
  2. Peptic ulcer bleed – Management issues.
  3. Advances in diagnosis of biliary tract diseases.
  4. Evaluation of Obscure Gastrointestinal bleed.
  5. Antibiotic associated diarrhea.
  6. Hepatocellular carcinoma – scoring systems and targeted molecular agents.
  7. Approach to Portal Hypertension
  8. Vaccination
  9. Genetic basis of pancreatic diseases
  10. Focal nodular Hyperplasia of liver
 
 
 
 
 
 
iv. Postgraduate Teaching for M.D. (General Medicine)
 
Each year, MD (Gen Med) postgraduate students are posted in batches for a period of one month.  During this period they are allotted beds, are taught patient care and cases discussed.  The postgraduates are exposed to endoscopy procedures – including UGI endoscopy and colonoscopy.  Procedures such as liver abscess drainage and liver biopsy are also taught.  Training includes radiological interpretation. Symposium on important topics is held on Saturdays.  At the end of the training, the candidates have a written and clinical test
 
Medal exam named as Prof N. Madanagopalan Prize Exam in Medical Gastroenterology is conducted in Nov / Dec of each year for MD and final MBBBS students.  The examiners are in service/former professors of Medicine and Gastroenterology.  The prize consists of a Medallion and a certificate.
Prof N Madanagopalan Medal MBBS:  Ms Malini
 
CME and Workshops
 
Prof A.R.Venkateswaran attended
 
  1. ISG conference at Sep 2011 Thenkasi, Courtallam
  2. Indo American advanced endo workshop at Visakapatnam
  3. TN state ISG annual meet in Feb 2012 at Salem
  4. ISG monthly meeting
  5. Digestive endoscopy week- Hyderabad Feb 2012, Chennai
  1. ISGCON 2011, Coimbatore, November
     
 
Post graduate training for DM postgraduates – conferences attended
 
1. Mid term ISG conference at Courtallam
2. TN state ISG annual meet in Febrary 2012 at Salem
3. ENDOCON 2011, Hyderabad
4. ISG monthly meeting
5. ISGCON 2011, Coimbatore, November
6. INASL 2012, Gauhati.
 
 
 
 
Research Activities
The department has major interests in basic research like epidemiology of various gastrointestinal disorders, natural history of various GI disorders.  Papers published are widely acclaimed in National forums and is serving as guidelines for management of very many GI disorders.
Post graduate Students:
Dr. Raja and Dr. Sridhar: successfully completed the DM course
Dr. B. Sivasubramaniam and Dr.V.Arul Selvan: final year:
Dr.Harriprasad and Dr Preethi: second year
Dr.Satyamurthi and Dr. Ramesh Kumar – first year

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