Specialized Pancreatology & Biliary Suite
Pancreas & Biliary Conditions
Expert emergency triage and advanced therapeutic endoscopy (ERCP, SpyGlass Cholangioscopy, EUS Cystogastrostomy) for Acute & Chronic Pancreatitis, Pancreatic Pseudocysts, and Bile Duct Obstructions by Sir Ganga Ram Hospital Fellow Dr. Ankita Gupta.
SGRH FellowAdvanced Biliary Interventions
ERCP ProtocolIncisionless Bile Clearance
EUS DrainageInternal Pseudocyst Stenting
Celiac BlockChronic Pain Management
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Acute Pancreatitis
Acute pancreatitis is a sudden, potentially life-threatening chemical inflammation of the pancreas, most frequently triggered by migrating gallstones blocking the pancreatic duct or heavy alcohol consumption.
Symptoms & Warning Signs
- Sudden, excruciating upper abdominal pain radiating straight through to the back
- Pain exacerbated by eating and somewhat relieved by sitting upright or leaning forward
- Persistent severe nausea, dry retching, and unyielding vomiting
- Rapid heart rate (tachycardia), low-grade fever, and abdominal tenderness
GLEC Diagnostic Workup
- Markedly elevated Serum Lipase and Amylase (>3 times upper limit of normal)
- High-definition emergency Ultrasound to evaluate gallstones and CBD diameter
- Contrast-Enhanced CT (CECT) Abdomen performed at 72-96 hours to assess pancreatic necrosis (Balthazar score)
- Serum calcium, triglycerides, and liver function panel to establish root etiology
Treatment & Management
- Aggressive, goal-directed intravenous fluid resuscitation in initial 24 hours
- Intensive pain control and early enteric nutrition via specialized feeding tubes
- Emergency ERCP with sphincterotomy if concurrent gallstone cholangitis is present
- Prophylactic avoidance of surgery for sterile necrosis; step-up drainage if infected
Protocol curated by Dr. Ankita Gupta (DM Gastroenterology, Gold Medalist)
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Chronic Pancreatitis & Pain Management
Chronic pancreatitis is progressive, irreversible fibro-inflammatory damage to the pancreatic tissue, resulting in calcification, ductal strictures, debilitating pain, and loss of both digestive enzymes and insulin production.
Symptoms & Warning Signs
- Recurrent or continuous deep epigastric pain boring through to the back
- Steatorrhea: Pale, bulky, foul-smelling greasy stools that float or stick to the pan
- Severe unexplained weight loss despite eating due to lack of digestive enzymes
- Development of 'pancreatogenic' brittle diabetes (Type 3c diabetes)
GLEC Diagnostic Workup
- Endoscopic Ultrasound (EUS) - most sensitive test for early parenchymal and ductal changes (Rosemont criteria)
- MRCP (Magnetic Resonance Cholangiopancreatography) with secretin stimulation
- Non-contrast CT abdomen showing dense intraductal pancreatic calcifications
- Fecal Elastase-1 test proving exocrine pancreatic insufficiency (EPI)
Treatment & Management
- High-potency enteric-coated Pancreatic Enzyme Replacement Therapy (PERT) with meals
- Endoscopic pancreatic duct stone clearance (ESWL lithotripsy) and stenting via ERCP
- EUS-guided Celiac Plexus Neurolysis (CPN) block for long-term narcotic-free pain relief
- Strict abstinence from alcohol and smoking to prevent disease progression
Protocol curated by Dr. Ankita Gupta (DM Gastroenterology, Gold Medalist)
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Pancreatic Pseudocysts & Walled-Off Necrosis
A pseudocyst is an encapsulated collection of pancreatic fluid rich in enzymes that develops 4 or more weeks following acute pancreatitis. If large, it causes gastric outlet obstruction or can become infected.
Symptoms & Warning Signs
- Persistent feeling of fullness, abdominal bloating, and early satiety
- Palpable, tender epigastric mass in the upper belly
- Nausea and vomiting after eating due to cyst compressing the stomach
- Fever, chills, and high WBC count if the pseudocyst becomes infected (pancreatic abscess)
GLEC Diagnostic Workup
- Endoscopic Ultrasound (EUS) evaluating cyst wall thickness and debris content
- CECT Abdomen mapping relationship to major splenic and mesenteric blood vessels
- MRCP to evaluate whether the pseudocyst communicates with main pancreatic duct
Treatment & Management
- EUS-guided Cystogastrostomy using Lumen-Apposing Metal Stents (LAMS / Hot Axios)
- Completely scarless internal drainage through stomach wall under real-time ultrasound
- Endoscopic necrosectomy to debride necrotic tissue inside cyst cavity
- Zero external tubes, zero drainage bags, and discharge within 48 hours
Protocol curated by Dr. Ankita Gupta (DM Gastroenterology, Gold Medalist)
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Pancreatic Tumors & Cystic Lesions
Pancreatic neoplasms include ductal adenocarcinoma (the most common solid tumor) as well as mucinous cystic neoplasms (IPMN, MCN) and neuroendocrine tumors (pNETs). Early EUS detection allows curative surgical resection.
Symptoms & Warning Signs
- Painless, progressively deepening obstructive jaundice (yellow eyes, tea-colored urine)
- Unexplained rapid weight loss, severe anorexia, and new-onset diabetes in adults >50
- Dull epigastric ache radiating into the lumbar spine
- Pruritus (severe body-wide skin itching without a rash)
GLEC Diagnostic Workup
- High-definition linear Endoscopic Ultrasound (EUS) detecting tumors smaller than 1 cm
- EUS-guided Fine Needle Biopsy (EUS-FNB) with real-time on-site cytopathology (ROSE)
- Triple-phase contrast Pancreatic Protocol CT scan
- Serum CA 19-9 tumor marker quantification
Treatment & Management
- Referral for surgical resection (Whipple procedure / Pancreaticoduodenectomy) for resectable cases
- Endoscopic placement of Self-Expanding Metal Stents (SEMS) via ERCP for jaundice relief
- EUS-guided fiducial placement and celiac block for advanced oncological care
- Multidisciplinary tumor board staging and neoadjuvant systemic therapy
Protocol curated by Dr. Ankita Gupta (DM Gastroenterology, Gold Medalist)
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Bile Duct Strictures & Cholangiocarcinoma
Strictures (narrowing) of the common bile duct can arise from previous gallbladder surgery, chronic pancreatitis, or malignant tumors of the bile ducts (cholangiocarcinoma / Klatskin tumor).
Symptoms & Warning Signs
- Progressive jaundice, dark tea-colored urine, and clay-white stools
- Severe generalized itching (pruritus)
- High-grade fever with shaking chills and rigors (ascending cholangitis)
- Upper right quadrant tenderness and loss of appetite
GLEC Diagnostic Workup
- MRCP showing exact level and extent of biliary duct dilatation
- SpyGlass Digital Single-Operator Cholangioscopy for direct visual camera inspection inside the bile duct
- Targeted SpyBite intraductal biopsy for definitive histopathology
- Serum Bilirubin, Alkaline Phosphatase, and CA 19-9 markers
Treatment & Management
- Endoscopic balloon dilatation of benign postoperative strictures
- Placement of multiple side-by-side plastic stents or covered metal stents
- Radiofrequency Ablation (RFA) inside the bile duct for unresectable cholangiocarcinoma
- Emergency drainage to cure life-threatening bacterial cholangitis
Protocol curated by Dr. Ankita Gupta (DM Gastroenterology, Gold Medalist)