Interviews

Endoscopic Ultrasound has added a new dimension in Gastroenterology

dr-piyush-ranjan

Dr. Piyush Ranjan,Senior Consultant, Gastroenterology at Sir Gangaram Hospital has done his DM Gastroenterology training from the prestigious SGPGI, Lucknow. He did his MD from Maulana Azad Medical College. He has worked in different hospitals including the SGPGI, Lucknow and MAMC, Delhi while building his academic profile. With more than 50 papers published on various platforms including world renowned medical journals. Dr Ranjan in an interaction with Ekta Srivastava, Health Technology…

How did you get into medicine, and what motivated you to become a doctor?

Medicine in my view is a profession which gives scope for practical research, innovation and service to society. There are ample career opportunities in both public and private sectors making it a stable choice.

In your opinion, what are the most difficult or challenging aspects of your career as a gastroenterologist?

The biggest challenge in my opinion is to provide state of the art treatment at affordable costs. In a country like ours where most people have out of pocket expense of their treatment rationalization of cost without compromise in quality in a herculean task.

What is latest in pancreatic cancer with regard to evolution and treatment?

Pancreatic cancer has got poor outcome of treatment. The biggest challenge is to diagnose it earlier by better diagnostic means. Newer investigation modalities like Endoscopic ultrasound have, to a large extent, helped in bridging this gap.

Curative treatment of pancreatic cancer involves surgery. The standard surgical procedure is Whipples surgery, which carries a significant morbidity (complications) and mortality. Recent application of Laparoscopic and Robotic techniques has helped in bringing down the complications of this surgery and helping in early recovery.

Minimal Access Surgery is in vogue but not for pancreatic cancer. How has this evolved and what is the scope?

Availability of technology and better training has now helped in application of laparoscopic technique for Whipple’s surgery (Surgery for pancreatic cancer). At present the biggest hurdle in application of laparoscopic Whipple’s is the lack of well-trained surgeons in large numbers. It is just a matter of time when there will be a major shift towards this.

Tell us about Laparoscopy in GM malignancy.

Laparoscopy is now considered the standard of care in colonic carcinoma. The results are comparable ore even better than open surgery. Early recovery and discharge is the biggest advantage of laparoscopic surgery in colonic cancer. Laparoscopic surgery is also coming up with resection of liver tumours. In Gall bladder cancers the biggest challenge is that these tumours present at an advanced stage.

What is the training that is given in order to perform a basic laparoscopic surgery?

Most General surgery training programmes giver adequate exposure in basic laparoscopic training. Many high volume centres provide fellowship programmes.

What advice would you give someone considering a career as a physician, particularly in gastroenterology?

Medicine is an evolving field so one should be willing to be upgrade throughout life. Gastroenterology is a mix of medical skills and endoscopic skills. Newer procedures and areas like liver transplantation offer a vast range of choices for sub-specialization.

How do you think that the field of gastroenterology is going to change over the next 10 years, and how will that impact GIs?

There are many exciting developments in the field of Gastroenterology. Endoscopic Ultrasound has added a new dimension in the overall management paradigm. Now “Third space Endoscopy”, which involves procedures like POEM (Per Oral Endoscopic Myotomy) for treatment of Achalasia cardia has opened new frontiers. NOTES (Natural Orifice Transluminal Endoscopic Surgery) is another area which will open new vistas for Gastroenterologists. Liver transplantation offers huge opportunity in future.

 

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