What is IRC :
Infra Red Coagulation used in a number of conditions is commonly being used for office treatment of hemorrhoids worldwide.

How is it done :
Infra Red Rays are applied just at the base of the piles mass through the proctoscope..

Why is it done :
It is performed to cause coagulation of the tissues in a timer controlled fashion so as to give good results with no complications.

Is it painful :
IRC does not have any pain associated with the procedure.

What is the cost :
We are charging Rs. 4500 / - for upto three sittings of IRC. If any of our patients do not benefit with IRC and require surgery we have even offered to include the IRC charges in our surgery charges.

What are the complications :
No major complication are known of IRC. It is a painless procedure. The natural course of the disease may however cause problems during treatment including bleeding.

What is E.R.C.P. :
The full name of the procedure is Endoscopic Retrograde Cholangio Pancreatography. A combination of endoscopy and radiology (image intensifier) is used to examine areas not approachable with the endoscopes.

How is it done :
From the patients point of view it involves insertion of a slightly thicker endoscope through the mouth, though technically from the endoscopists' point of view it is far more complicated than UGI endoscopy.

Why is it done :
It is done to examine the biliary and pancreatic ductal systems. Most common indication for ERCP is obstructive jaundice. Usually done with full consent for therapeutics also as any stones / obstruction found has to be tackled immediately.

Is it painful :
Discomfort of ERCP for the patient is definitely more than that of UGI Endoscopy though all patients for ERCP in ourcenter are given good sedation and analgesia.

What is the cost :
Pure diagnostic Side viewing endoscopy with biopsy is Rs. 3700 /-, But therapeutics including spinchterotomy, nasobiliary drainage, stone extraction etc. are usually performed in nearly all patients and total cost of Therapeutic ERCP including cost of dye / plastic stents / other disposables, work out in the region of Rs. 15000 / - and Mechanical lithotripsy is Rs 35000/- at our center.

What are the complications :
Many complications are reported with ERCP but the common are; Acute pancreattitis, Bleeding and perforation. We have faced all these complications and with our major operation theatre and inpatient backup we ahve been able to manage all our patients. Occasionally however patients need to be referred to higher centres for procedures / facilities not being provided by us. we are lucky to have premier institute like PGIMER in our vicinity with capable and highly cooperative consultants.

What is Colonoscopy :
Visualisation of the large intestines upto caecum per rectally using a flexible Colonoscope.

How is it done :
A flexible tube is passed through the rectum after proper cleaning of the intestines. Local anesthetic jelly lubrication is used. Sedation and analgesics are used in about 30% of all colonoscopies. Preperation for colonoscopy is done by giving the patient Peglec powder dissolved in 2 ltrs. of water. Patient drinks this solution as much as possible preferably over one hour and can come for the procedure after 4 - 5 hrs.

Why is it done :
Direct examination in color being superior to black and white barium enema, early malignancy and mucosal abnormalities are better picked up with colonoscopy. Biopsy and occasionally treatment like removal of small tumors / polyps can be done in the same sitting.

Is it painful :
Some amount of discomfort is associated with a full length colonoscopy but most patients can get the procedure done without any sedation / analgesia. However about 30% of our patients requires sedation / analgesia to complete the procedure.

What is the cost :
Full length Colonoscopy costs Rs. 2000 / - in our centre with photographs.

What are the indications for colonoscopy :

Colonoscopy is generally indicated in the following circumstances:

1. For evaluation of unexplained GI bleeding a) Hematochezia b) Malena after an upper GI source has been excluded c) Presence of  fecal occult blood

2. Unexplained iron deficiency anaemia.

3. Screening and surveillance for colonic neoplasia

What are the complications :
Diagnostic Colonoscopy should again be free of any major complication in trained hands. Occasionally perforations have been reported.

What is Endoscopy :
It is a procedure that enables your physician to examine the lining of the upper part of your gastrointestinal tract i.e. the esophagus (swallowing tube) stomach and duodenum (first portion of small intestine ) using a thin flexible tube with its own lens and light source.

How is it done :
A thin flexible tube (Endoscope) is passed through the mouth after local anesthesia. Usually no sedation is needed or given. The total time the procedure takes is 5 - 7 minutes..

Why is it done :
Direct visualisation in color being superior to black and white barium. Biopsy or treatment if needed can be performed during the procedure itself.

Is it painful :
The difficulty in swallowing a large capsule or on gaging while cleaning the back of tongue should be the maximum discomfort during UGI Endoscopy. In trained hands with with good quality equipment there should be no pain with it.

What is the cost :
Our costs are among the lowest in the country. Endoscopes can be purchased from rs. 1.5 lacs to Rs. 14 lacs depending upon the quality of image and thickness of the insertion tube. Using the latest technology of videoscopes from the number one producer in the world i.e. OLYMPUS, UGI Endoscopy with photographs costs Rs. 1500 / - with us.

What are the indications for UGI Endoscopy:                                                                                                                                                            

Specific indications for UGI Endoscopy

1. Upper abdominal symptoms that persist despite an appropriate trial of therapy
2. Abdominal symptoms associated with other symptoms or signs suggesting structural disease(eg, anorexia and weight loss) or new –onset symptoms in patients older than 50 years of age.
3. Dysphagia or odynophagia.
4. Esophageal reflux symptoms that persist or recur despite appropriate therapy.
5. Persistent vomiting of unknown cause.
6. Other diseases in which the presence of upper GI pathology might modify other planned management. Examples include patients who have a history of ulcer of GI bleeding who are scheduled for organ transplantation, long- term anticoagulation or nonsteroidal anti-inflammatory drug therapy for arthritis and those with cancer of the head and neck.
7. Familial adenomatous polyposis syndromes.
8. For confirmation and specific histologic diagnosis of radiologically demonstrated lesions:                                                                                    1) Suspected neoplastic lesions.                                                                                                                                                                      2) Gastric or esophageal ulcer.                                                                                                                                                                        3) Upper tract stricture or obstruction.
9. GI bleeding: 1)In patients with active and recent bleeding.                                                                                                                                           2) For presumed chronic blood loss and for iron deficiency anaemia when the clinical situation suggests an upper GI source or when colonoscopy doesnot provide any explanation.
10. When sampling of tissue or fluid is indicated.
11. Selected patients with suspected portal hypertension to document or treat esophageal varices.
12. To assess diarrhea in patients suspected of having small-bowel disease(e.g,celiac disease).
13. Treatment of bleeding lesions such as ulcers ,tumors,vascular abnormalities(e.g,elecrtrocoagulation,heater probe,laser photocoagulation,injection therapy).
14. Removal of foreign bodies.
15. Removal  of selected lesions.
16. Placement of feeding or drainage tubes(e.g.peroral,percutaneous endoscopic gastrostomy,percutaneous endoscopic jejunostomy).
17. Dilation and stenting of stenotic lesions(e.g with transendoscopic balloon dialators or dilation systems using guidewires).
18. Management of achalasia(eg,botulinum toxin, balloon dilation).
19. Palliative treatment of stenosing neoplasms(e.g, laser multipolar eletrocoagulation,stent placement).
20. Endoscopic therapy of intestinal metaplasia.
21. Intraoperative evaluation of anatomic reconstructions typical of modern foregut surgery(e.g, evaluation of anastomotic leak and patency, fundoplication formation, pouch configuration during bariatric surgery).
22. Management of operative complication(e.g, dilation of anastomotic strictures, stenting of anastomotic disruption, fistula, or leak in selected circumstances).

What are the complications :
Diagnostic UGI Endoscopy should not have any complication whatsoever in trained hands. Sore throat may be felt in some patients for 2 - 3 days. Bacteraemia in elderly, esophageal perforation and impaction of endoscope have been rarely described in case reports. Reactions to medications used rarely occur.