Gastroenterology

Endoscopic services provided by GI unit at ESH

• Upper GI Endoscopy ( Esophago-Gastro-Duodenoscopy), with detailed and thorough examination of upper GI tract ( esophagus , stomach and duodenum),high level expertise in using NBI ( narrow band imaging ) to detect early pre-malignant and malignant lesions
• Colonoscopy, detailed and through examination with extensive experience in detecting, pre cancers and cancerous lesion
• Advanced therapeutic endoscopic procedures including;
• 1-EMR ( Endoscopic Mucosal Resection) of large polyploidy lesions, pre-cancerous and cancerous lesions ( early stages), in the colon, Esophagus, and stomach, avoiding patients to undergo major surgical intervention and large operations
• 2-Placement of esophageal, duodenal and colonic metal stents, to relieve obstruction.
• 3-CRE Balloon dilatation of strictures in esophagus, stomach, duodenum and colon.
• 4- Endoscopic management of gastrointestinal tract bleeding, both upper and lower GI tract ( esophagus, gastric, small intestine and colon), including ; adrenaline injection, APC ( Argon Plasma Coagulation), Gold Probe treatment, Endoscopic clips, , Esophageal varices banding, Histo-Acryle Glue injection to gastric varices.
• Diagnostic and Interventional EUS ( Endoscopic Ultrasound)
• obtaining samples ( FNA) from lesion in pancreases, liver, Para esophageal and intra-abdominal lymph nodes, submucosal benign and malignant lesion in esophagus, stomach, duodenum and distal colon.
• Detailed and accurate assessment of pancreatic and biliary system
• Staging of esophageal, gastric , pancreatic and rectal tumors
• Advanced Therapeutic ERCP;
• Extraction of multiple and large common bile duct stones (CBD) stones ( gall stones fallen into the biliary system) using balloon and lithotripsy
• Plastic and Metal biliary stent insertion to relieve biliary strictures
• CRE balloon dilation and cytology brushing of biliary strictures
• Single and Double balloon Enteroscopy for assessment of small intestinal
• Both diagnostic and Therapeutic
• Capsule Endoscopy for assessment of small intestine
• Gastric Baloon for weight reduction

Appropriate Indications for Gastroenterology Referrals

• Reflux symptoms ( heart burn) ;
• Uncontrolled with medical therapy ( 4 weeks of PPI therapy)
• Controlled with PPI therapy, but more than 5 years , plus any two of the following critera
• BMI > 30
• male patient
• white
• hiatus hernia
• > 50 years old
• positive Fhx for esophageal cancer
• Persistent or recurrent Helicobacter infection
• New onset dyspepsia in any patient > 50 years old
• Dysphagia at any age, all types, new onset, progressive, intermittent
• Non cardiac chest pain
• chronic cough ( respiratory causes excluded)
• Abdominal pain, new onset, chronic , intermittent
• Weight loss
• patient > 40 year old, with change in bowel habit, shape, caliber, consistency, frequency
• Diarrhea > 4 weeks ( chronic ), persistent or intermittent
• fecal consistence
• Constipation
• Rectal bleeding ( any), melena
• positive Fhx for colon cancer
• positive Fhx for Gastric cancer
• Anemia
• Iron deficiency in male patient > 50 years old
• Vitamin B12 deficiency
• positive FIT test
• Overweight

Services Provided at ESH

• Investigations and management of weight loss, diarrhea, rectal bleeding, un-explained and vague abdominal symptoms
• Diagnosis and management of Gastro-Esophageal Reflux Disease (GERD), including medical, endoscopic and surgical management
• Diagnosis and management of esophageal dysmotitly ( e.g diffuse esophageal spasm, achalasia)
• Medial and surgical treatment for Barrett’s esophagus
• Diagnosis and management of Peptic Ulcer Disease.
• Treatment Helico-bacter infection, persistent or recurrent
• Diagnosis and management of non ulcer dyspepsia
• diagnosis and management of celiac disease
• Diagnosis and management of inflammatory bowel disease ( ulcerative colitis, Crohn’s disease), with extensive experience in the use of immunomodulators and biologic therapy
• Diagnosis and management of function bowel disorders ( e.g Irritable bowel syndrome)
• Diagnosis and management of acute and chronic liver diseases, including Viral hepatitis ( hepatitis A, hepatitis B, hepatitis C, hepatitis E and hepatitis D), Haemochromatosis, Fatty Liver Disease, NASH ( Non Alcoholic SteatoHepatitis), AIH ( Autoimmune hepatitis), PBC ( Primary Biliary Cirrhosis), Wilson’s disease, alfa-1 antitrypsin deficiency,
• Management of pre- and post liver transplant care ( UK experience, Queen Elizabeth Liver Transplant Centre)
• Diagnosis and management of solid and cystic pancreatic lesions, including benign,
• pre-malignant and malignant lesions, ( IPMN, intrapapillary mucinous neoplasm, serous cyst adenoma, mucinous cyst adenoma, pancreatic neuroendoscrine tumours, pancreatic adenocarcinoma)
• Assessment , diagnosis and management of biliary diseases, including medical, endoscopic and surgical management ( Gallstones, CBD stones ( choledocholithisis), benign and malignant biliary strictures, PSC ( primary sclerosing cholangitis, cholangicarcinoma, anastomotic biliary strictures)
• Weight reduction clinics, including medical management, gastric balloon placement, gastric sleeve and gastric bypass surgery

• Abnormal Liver function test
• Abnormal pancreatic function test
• Liver, pancreatic or biliary abnormalities on imaging ( Ultrasound / CT scan)
• Colon cancer screening candidates
• Any patient > 40 years old
• positive Fhx for colo-rectal cancer
• Hx of IBD ( inflammatory bowel disease, i.e Ulcerative colitis or Crohn’s disease)
• History of colonic polyps
• Gastric cancer screening
• Atrophic gastritis
• pernicious anemia
• Hx of gastric polyps
• positive Fhx for gastric cancer