The only centre under GNCTD performing Liver and Kidney transplants.

Hepatology

Hepatology

Our mission is to develop Hepatology as a comprehensive discipline of medicine which can provide distinctly advanced and protocol based patient care, training and clinical and translational research. The Hepatology department at ILBS provides emergency and elective management to patients with liver, biliary and pancreatic diseases by a highly specialized and dedicated team of faculty, residents and supportive staff. With a rigorous academic program and constant monitoring and mentoring, the department is able to provide protocol and evidenced based care to an increasing number of difficult to treat patients.The department has initiated efforts to promote the study of Hepatobiliary Sciences as a super-specialty and initiated advanced training in the field of Hepatology and Transplant Hepatology.

Adult Hepatology Services: Diagnosis and treatment of viral hepatitis (Hepatitis B, C, E, A and D), alcoholic liver disease, fatty liver disease, auto-immune hepatitis, drug hepatitis, and all causes of jaundice. Gall stones and bile duct stones; pancreatic diseases; Liver, gall bladder and GI cancers. The following specialized services are being routinely provided at hepatology department:

A). Liver Intensive Care:

The institute has established one of the finest liver intensive and critical care services with specialized rapid response teams.We provide care guided by a protocol-based treatment and rapid response by a multidisciplinary team ably supported by the nephrology, cardiology, pulmonology teams.

 

annual annual
aclf

These newer developing therapies have demonstrated benefits in biochemical parameters, systemic hemodynamics, hepatic encephalopathy and also renal functions but are expensive and enough data is available on safety of these devices. They can be used as a bridge for spontaneous recovery or transplantation in patients with ALF. In patients with acute on chronic liver failure (ACLF) with hepatorenal syndrome or hepatic encephalopathy (without contraindications for transplantation) in order to improve their chances to be listed and transplanted.

These newer developing therapies have demonstrated benefits in biochemical parameters, systemic hemodynamics, hepatic encephalopathy and also renal functions but are expensive and enough data is available on safety of these devices. They can be used as a bridge for spontaneous recovery or transplantation in patients with ALF. In patients with acute on chronic liver failure (ACLF) with hepatorenal syndrome or hepatic encephalopathy (without contraindications for transplantation) in order to improve their chances to be listed and transplanted.

We at ILBS have the Prometheus system, the first of it’s kind in India.

We at ILBS are also trying to develop our “bioartificial liver” with extracorporeal bioreactors containing hepatocytes which can provide additional synthetic and biotransformatory liver functions, which may be more effective than completely artificial systems like Prometheus which provide excretory capacity alone.

  • Acute G I Bleeds: Patients with acute GI bleed are seen immediately in the emergency room and appropriate treatment is given immediately (Door to needle time <30 mins) including emergency endoscopy (door to scope time about 3 hours) throughout the year (24x7) which has resulted in keeping mortality to around 14% in patients with UGI bleed. Patients who fail the combination of endotherapy and vasoactive agents are taken up for portal pressure (HVPG) measurement and if suitable, considered for emergency TIPS procedure. There is a dedicated team available round the clock for all these procedures. New intervention of placing self-expanding metal stent, the Danis Ella Stent has greatly improved control of refractory variceal bleeding and patient survival. Probably the highest number of such stents are placed in the country, at the ILBS.

  • Hepatic coma: Hepatic encephalopathy is the occurrence of confusion, altered level of consciousness, and coma as a result of liver failure. It may ultimately lead to death. A substantial increase in the patients admitted with hepatic coma occurred in the past one year. These patients are managed based on standard protocols and with our state of the art hepatic coma ICU functioning. New ammonia targeted approaches were introduced in with improved outcomes.

  • Acute Liver failure: Acute liver failure is the appearance of hepatic encephalopathy rapidly after jaundice, and indicates that the liver has sustained severe damage. Common causes include Hepatitis E, Hepatitis A, and drugs. ILBS has been involved in the treatment of ALF patients with a rapid response team working round the clock and with the availability of urgent liver transplantation the outlook of this disease has improved substantially. Specialized monitoring with Optic Nerve Sheath Diameter (ONSD) measurement and transcranial Doppler improved our diagnostic capabilities. Apart from this, we do high-volume plasma-exchange which removes a wide array of inflammatory toxins and cytokines in these patients and therefore facilitates recovery of the failing liver by providing an environment conducive for liver regeneration. High-volume plasma exchange in patients with acute liver failure is offered as a bridging therapy to spontaneous regeneration or liver transplantation. We routinely do plasma exchange for liver failure and have done this therapy in more than 100 patients in our intensive care unit, which is again probably the highest in the country. An early continuous renal replacement therapy (CRRT) in patients with acute liver failure is routinely done at our center. We have also successfully offered a combination of these therapies in few patients with improved outcomes.

  • Acute on Chronic Liver failure[ACLF]:Liver failure can develop either acutely in the absence of any pre-existing liver disease [i.e. acute liver failure or ALF] or as acute on chronic liver failure (ACLF) which denotes a sudden deterioration of known or unknown chronic liver disease patient, which can be life threatening and requires intensive ICU care. This entity was first defined in India and ILBS has henceforth carried intensive research in this disease and developed effective treatments for this deadly condition. ILBS serves as the nodal center for the Asian Pacific Association for the Study of the Liver ACLF Research Consortium (AARC).

  • At ILBS, there has been an ever-increasing referral of patients for management of these emergencies as shown in the figure below. 
  • Liver dialysis :Artificial liver support systems can be non-cell based or cell-based systems. Several non-cell based extracorporeal liver support systems like hemodialysis, hemofiltration, plasma exchange, charcoal perfusion have been used in the past with a goal to remove the putative toxins and inflammatory cytokines to allow additional time for the liver to recover or as a bridge to liver transplantation. However, in all these protein bound toxins are removed to only a minor extent. Single pass albumin dialysis (SPAD) , molecular absorbent and recirculation system (MARS) and recently, Prometheus (FPSA–fractional plasma separation and adsorption) which remove both water soluble and protein bound toxins have emerged as liver support therapies in patients with acute and acute on chronic liver failure. The Prometheus system which combines the FPSA method with high-flux hemo-dialysis (of the blood) in an extracorporeal detoxification system. These newer developing therapies have demonstrated benefits in biochemical parameters, systemic hemodynamics, hepatic encephalopathy and also renal functions but are expensive and enough data is available on safety of these devices. They can be used as a bridge for spontaneous recovery or transplantation in patients with ALF. In patients with acute on chronic liver failure (ACLF) with hepatorenal syndrome or hepatic encephalopathy (without contraindications for transplantation) in order to improve their chances to be listed and transplanted. We at ILBS have the Prometheus system, the first of it’s kind in India. We at ILBS are also trying to develop our “bioartificial liver” with extracorporeal bioreactors containing hepatocytes which can provide additional synthetic and biotransformatory liver functions, which may be more effective than completely artificial systems like Prometheus which provide excretory capacity alone.
  • Acute Kidney Injury (AKI): is a frequent and ominous complication in critically ill cirrhotics. AKI in these patients is usually a result of systemic inflammation and bacterial infection. In the remaining patients, diuretic use, large volume paracentesis, variceal bleed, use of nephrotoxic medications or structural kidney damage are other potential causes. Apart from routine management of AKI which includes discontinuation of nephrotoxic drugs, vasodilators,non-steroidal anti-inï¬ÂÂÂÂ?ammatory drugs and diuretics, antibiotics, volume expansion with intravenous albumin and additional use of terlipressin and noradrenaline is considered for non-responsive AKI or hepatorenal syndrome. Since the response to vasoconstrictors is seen in only one third, renal replacement therapy is frequently required. Our liver intensive care is equipped with 24x7 dialysis services. We provide intermittent hemodialysis, slow low exchange dialysis (SLED) as well as continuous renal replacement therapy (CRRT). Continuous RRT is better tolerated than routine hemodialysis in liver patients because of improved cardiovascular stability and less effect on intracranial pressure. With the able support of the nephrology team, more than 2,000 SLED procedures and more than 300 CRRTs have been done till date in patients with liver failure with AKI. We have also effectively combined hemodialysis with hemoperfusion as a technique to remove different toxins (bile acids, ammonia, cytokines) that accumulate in patients with liver failure and for endotoxin removal in patients with septic shock.
  • End of Life Care: In patients with cirrhosis end of life is an important aspect of ICU care wherein the patients either are in a persistent state of coma, have requirement of indefinite life support with no curative possibilities which may lead to economic ruin in face of medical futility and no benefit. After a consensus opinion within the ICU team care providers the decision for end of life is discussed with the family. As a part of this, care is focused on palliating a terminally ill patient’s pain and other symptoms and attending to their and their family’s emotional and spiritual needs.
  •  


    annualThese newer developing therapies have demonstrated benefits in biochemical parameters, systemic hemodynamics, hepatic encephalopathy and also renal functions but are expensive and enough data is available on safety of these devices. They can be used as a bridge for spontaneous recovery or transplantation in patients with ALF. In patients with acute on chronic liver failure (ACLF) with hepatorenal syndrome or hepatic encephalopathy (without contraindications for transplantation )- to improve their chances to be listed and transplanted.

    We at ILBS have the Prometheus system, the first of it’s kind in India.

    We at ILBS are also trying to develop our “bioartificial liver” with extracorporeal bioreactors containing hepatocytes which can provide additional synthetic and biotransformatory liver functions, which may be more effective than completely artificial systems like Prometheus which provide excretory capacity alone.

B). Viral Hepatitis (A,B,C,E) and Hepatocellular Carcinoma Services:

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  • Hepatitis B and C are common causes of chronic liver disease in India and nearly 45 and 12 million people are estimated to be infected with these viruses in India respectively. They are also the common cause of cirrhosis and liver cancer

C). Alcoholic liver disease:

At ILBS, alcoholic liver disease is the most common diagnosis requiring admission. ALD constitutes more than 40% of our in-patients and 2/3rds of our patients with acute-on-chronic liver failure. We have protocol based treatments available for alcoholic hepatitis patients led by Dr Shasthr. We have recently shown survival benefits in patients not responding to the standard of care with growth factors and those not eligible for standard of care with use of new protocols using fecal microbiota transplantation (FMT) from a healthy donor. We further are trying to standardize protocols, which could in future become the standard of care in the management of severe alcoholic hepatitis patients.

cirhotics

aclf1

D). Fibroscan (liver stiffness and fat measurement):

Early diagnosis and intervention can lead to a substantial reduction in morbidity and mortality from all conditions that lead to cirrhosis. Liver stiffness is important for evaluating the stage of liver fibrosis. The transient elastograpy (FibroScan®) technique measures the liver stiffness. This is used to quantify hepatic fibrosis in a totally non-invasive and painless manner, with no contra-indications for the patients. FibroScan allows accurate assessment of liver fibrosis resulting from all chronic pathologies that cause damage to the liver, including metabolic syndrome and non-alcoholic fatty liver disease, chronic viral hepatitis and excess alcohol intake. In the early stages of liver disease tests and conventional ultrasound have a poor predictive value in assessing fibrosis. Liver stiffness measurement is the ideal diagnostic tool to accurately identify liver fibrosis and fat quantification and is being increasingly used at ILBS.

fibroscan

E). Endoscopy Services:

The department of hepatology provides most comprehensive endoscopic services- both diagnostic and therapeutic. Our spacious endoscopy unit has seven fully equipped rooms- two for gastroscopy, one for colonoscopy, one each for endoscopic retrograde cholangiopancreatography (ERCP) and endoscopic ultrasound (EUS), cholangioscopy, Intraductal ultrasound, one balloon enteroscopy room, and one room for extra-corporeal shock wave lithotripsy (ESWL). Experienced endoscopists, nurses and anesthesiologists receive all patients in a spacious day care reception area, where they are assessed pre-procedure. All elective endoscopic procedures at ILBS are carried out with tailored sedation provided by consultant anesthesiologists. Patients undergoing prolonged procedures, and high-risk patients are administered general anesthesia with elective endotracheal intubation and ventilation. After the procedures, patients are monitored in a segregated post-procedure observation area with full monitoring facilities and privacy. We have a round–the-clock gastrointestinal bleeding service and a round the clock, GI Bleed unit with consultant endoscopists on 24-hour call. The highlights of the gastrointestinal bleeding service include a fully equipped ambulance with on-site resuscitation facilities, to triage at admission, and all endoscopic therapeutic procedures. These include variceal banding and injection, glue injection, thermal coagulation, argon plasma coagulation (APC), and hemostatic metallic stent implantation, Dennis Ela stent placement. We take pride in having the shortest ‘door to endoscopy’ time, which is unrivalled by any other hospital.

Our interventional radiology services work in tandem, and provide salvage angioembolization , TIPS and BRTO services for difficult to control or inaccessible bleeding sources. ILBS has one of the largest experiences in emergency TIPS stent placement. All patients with gastrointestinal bleeding are managed in an intensive care setting.
We provide comprehensive pancreato-biliary endoscopy services. These include Extra-corporeal shock wave lithotripsy (ESWL) to fragment pancreatic and bile duct stones, therapeutic ERCP, and diagnostic and therapeutic endoscopic ultrasound (EUS) procedures. We have the experience of one of the highest EUS procedures done in the country. All our EUS procedures are done under anesthesia, providing unsurpassed patient comfort and safety. We are the one of the center to have dedicated on-site cytopathology services, with EUS sampling adequacy rates exceeding 97%. We are routinely doing intra-gastric balloon (IGB) placements for management of patients with morbid obesity with perceivable results. Thirty-four IGB placements were done in 2017 alone.

We have the second generation cholangioscopy system and intra-ductal ultrasound systems for difficult biliary pathologies. We also have the holmium laser fiber system for cholangioscopic treatment of difficult bile duct stones. We are also introducing magnification and image-enhanced endoscopy, contrast-enhanced EUS, EUS-elastography, miniprobe sonography, and in-vivo histology by using probe-based laser confocal system. We are setting up a state-of-the art data archiving and management system, for audit and research purposes. Our endoscopy informatics system is integrated with the hospital PACS system.

The goal of endoscopy services at ILBS is amalgamation of cutting edge technology with a humane touch. We strive to make endoscopy a pleasant experience for all patients, with attention to small details including lockers for personal belongings, clean clothes and towels, clean toilet facilities, and post-procedure discussion of the findings. Our smiling and pleasant staff is trained to put patient apprehensions at ease.

There is ever increasing load of Endoscopic Procedures  through the years as shown in figures below.

endoer1
endoser2
endoser3

Abbreviations: Capsule E: Capsule endoscopy; SVE: Side-viewing endoscopy, EUS FNAC: Endoscopic ultrasound guided fine needle aspiration



Abbreviations: EVL: Endoscopic variceal ligation; APC: Argon plasma laser coagulation; HP: Heater probe; Glue: Glue injection; ERCP: Endoscopic retrograde chlolangiopancreatography, Others include Extra-corporeal shock wave lithotrypsy, Polypectomy and Achalasia Dilatation

F). Hepatic Hemodynamic Laboratory:

 

The hepatic hemodynamic laboratory is the backbone of Hepatology services. Under the supervision of Dr. Ankur Jindal, it provides detailed insight into the liver pressure which determines the outcome of patients with liver disease. Measurement of the hepatic venous pressure gradient (HVPG) is currently the best available method to evaluate the presence and severity of portal hypertension. Other unique features of this laboratory are accurate measurement of Pulmonary pressures, which is helpful in accurate diagnosis of porto-pulmonary hypertension and measurement of cardiac output; and simultaneous liver biopsy sampling even in patients with ascites and liver disease enabling accurate diagnosis and severity of liver disease.

The management of patients of liver disease is based on reduction in complications (such as variceal bleed, development of ascites and renal failure) and an opportunity to regenerate the liver. All this is done in a protocol and outcome based manner at the ILBS. Normal HVPG is <5 mm Hg and an HVPG >10 mm Hg (termed ‘clinically significant portal hypertension’ or CSPH) predicts the development of various complications of cirrhosis. Importantly, HVPG above 12 mmHg is the threshold level for variceal rupture and a reduction of HVPG to <12 mmHg or by 20% of baseline considerably reduces the risk of bleeding, mortality and other complications of cirrhosis, such as spontaneous bacterial peritonitis and hepatic encephalopathy. We are currently running protocols on HVPG response based approaches on primary prophylaxis of variceal bleed in cirrhotics and HVPG based approach for managing acute variceal bleed. Sequential HVPG measurements are helpful to optimize drug therapy or switch to another form of therapy.

The main advantages of the hepatic vein catheterization technique are its simplicity, reproducibility, and safety. Since its result has important implications, the appropriate and correct measurement of HVPG is an important issue both in research and clinical practice.

Because of its relatively invasive nature and domain skills, this facility is available in very few centers in the world. We at ILBS regularly perform this procedure taking due precautions that all the steps are performed with precision and patient safety.

hepatic

hepatichemodynamic

G). Quantitative Liver Functions Tests

At ILBS we have been able to standardize and establish two tests of quantitative liver functions, Indo-cyanin green (ICG)and  13C-Methacetin Breath Test (MBT). The MBT is a non-invasive, real-time molecular correlation spectroscopy assay which measures in expired breath, the abundance of 13C02 produced by hepatic cytochrome P450 metabolism of ingested non-radioactive 13C isotope-labeled methacetin, an acetaminophen precursor. MBT has been shown to assess the degree of derangement of liver metabolism in cirrhotics and preliminary data suggests that it correlates with the severity of portal hypertension (PHT). We at ILBS, performed a pilot study on 28 patients of cirrhosis due to various etiologies to investigate if MBT correlates with HVPG. MBT Cumulative PDR30 (Percent Dose Recovered at 30 min.) was the best variable and correctly detected CSPH, with an AUROC of 0.94 p<0.0001 irrespective of etiology of cirrhosis. Also, the PDR value of 13C-methacetin metabolites (i.e. breath 13C02) 30 minutes post-ingestion (PDR30), correlated with the degree of portal hypertension and HVPG (r=-0.54, p=0.0027).  Thus, it was concluded that  MBT can be recommended as a valuable non-invasive surrogate marker for the assessment of clinically significant PHT.

breathid

H). Clinical Nutrition

 

The department of Clinical Nutrition was established in ILBS, in 2012. The department is committed to providing nutrition management to the patients, along with nutrition education and research in collaboration with all the other departments at ILBS. Services for a detailed assessment of the nutritional status including the body composition analysis using a bioelectrical impedance analysis system are provided by the department. Specialized enteral nutrition formulations are routinely used for the patients. The department of clinical nutrition runs a dedicated liver nutrition clinic wherein along with the other referred cases, more than 250 obese cirrhotics are under follow-up. All these patients undergo a thorough nutritional work-up and nutritional management. In addition to this the department takes a lead in the routine nutritional management of patients in the ICU in consultation with the treating hepatoloist. This includes assessment of nutritional risk, initiation and management of eneteral and parenteral nutrition, assessment of nutritional adequacy and transition feeding. In the year 2017 more than 1000 body composition analysis using a bioelectrical impedance analysis system were provided by the department. Very soon the department would be offering the assessment of nutritional requirements through indirect calorimeter to the OPD as well as ICU patients.

Several nutrition related research projects are underway for the fulfillment of the degree of PGCC, PhD, DM and M.Ch students.

I). Liver regeneration and stem cell therapy

Only about 2-5% of patients, with advanced cirrhosis are able to get liver transplant. Lack of a donor, very advanced stage, financial and social issues are the major limitations. There is therefore an urgent need to provide alternative methods of maintaining and improving liver functions. In this regard, emerging science of regenerative medicine is considered an effective alternative therapeutic approach that can effectively manage the necro-inflammatory death of hepatocytes, potentiate immunomodulation and thus promote native liver regeneration and repair.

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In cirrhosis as well as in ACLF, the supportive signals for liver to regenerate get severely compromised and liver microenvironment becomes impermissible for regenerating cells, resulting in reduced liver mass and function. Potential of stem cells to differentiate into multiple cell lineages raises the exciting possibility that these cells can be used in repair and liver regeneration, when resident stem cells are not sufficient for the regeneration of a failing liver During liver regeneration, bone marrow-derived hematopoietic stem cells (HSC) may mobilize to the liver and, together with hepatocytes and intrahepatic stem cells, contribute to the proliferation of liver cells. Mechanistically, the approaches attempting to augment bone marrow stem cell can be divided into two main categories: enhancement of the endogenous stem cell response and augmentation of cell-based therapies by transplantation. Growth factor administration was shown to be a simple and novel method of mobilizing BMSCs. We at ILBS, have successfully used growth factors like granulocyte colony stimulating factor (G-CSF) and erythropoietin. S to mobilize stem cells to the periphery in patients with advanced cirrhosis and ACLF and shown survival benefit in a subgroup of these patients. It was shown that there is a senescence of bone marrow in patients with advanced cirrhosis. Patients with early decompensated cirrhosis (MELD<16) and those with a healthy cellular baseline BM respond better to growth factor therapy. Based on these concepts, growth factor administration after proper selection of patients is now a part of routine treatment of CLD patients at ILBS, particularly in those not having any option of transplant.

 

Several laboratorial and clinical studies showed that various cells, including mature hepatocytes in adult liver (adult HCs), fetal liver cells (FLCs), hepatic stem/progenitor cells (HSPCs), mesenchymal stromal cells (MSCs), are the potential sources of cell based therapies for liver failure, including acute on chronic liver failure as well as acute liver failure. Thus, our future endeavour in this field of regenerative hepatology includes novel interventional approaches, including transplant of bone marrow cells and/ or exosome infusion from allogeneic healthy bone marrow in the management of cirrhosis. Also we are studying the role of MSC transplant in management of ACLF patients. Utilization of macrophage therapy and/or CSF1 is also in our pipeline projects. Recently, in collaboration with IIT Kanpur, we have worked on a bio-artificial Liver (BAL) device to meet the metabolic demands of body. We have also worked on an emerging new approach of using decellularized liver for this purpose. We aim for a future in which no patient with liver disease dies due to failure to get liver transplant.

With this aim and with a strive to become a centre of Excellence for Hepatic Regenerative Therapies, ILBS has received grant from Department of Science and Technology (DST) for a project titled “DEVELOPMENT OF NON-TRANSPLANT THERAPEUTIC STRATEGIES FOR ADVANCED LIVER DISEASES”; phase 1 of which is ongoing.

J). Transplant Hepatology

 

Liver disease either acute or chronic when failed to improve with medical management, liver transplant is the therapy. Acute liver failure or acute on chronic liver failure require emergent transplant where as end stage liver disease needs a prompt and timing decision for the same. Our transplant team led by Prof Shiv K Sarin and monitored by Dr Ashok Choudhury. The students get unique opportunity to be exposed to this highly specialized care during their posting that includes pre transplant evaluation of donor and recipient, pre transplant optimization and post transplant follow up. The students also presented the clinical challenges in Liver Clinics of Indian Society Gastroenterology [Dr Vinod, Dr Shakti and Dr Juned). ILBS is the only public sector hospital in Govt setting to have a successful transplant programme with 101, 93 and 87 liver transplant per year in 2015, 2016 and 2017 respectively. This is possible due to able led by Transplant Surgery team by Prof Viniyendra Pamecha and Dr Senthil Kumar. Cadaver transplant, as well as mantainace of transplant waiting list in strict accordance of the NOTTO Guideline is a great achievement where nearly 250 patients were routinely followed by Transplant hepatology team and record maintained by Transplant Coordination department led by Mrs Vibhuti-a passionate and dedicated person. The post transplant care is offered by surgical and medical resident doctors, nursing staffs; 24x7 phone support (transplant SR on call mobile no-+91 7835055601), whatsapp support (mobile no-+91 9650951049), email (livertransplant@ilbs.in) and a dedicated post-transplant ward supervised by Dr Ashok Choudhury. Post transplant complications are uncommon; and if they occur, they are managed well. These include progressive multifocal leukoencephalopathy (PML), late onset antibody mediated rejection (AMR) in ABO compatible transplant, Graft Versus Host Disease (GVHD), post-transplant lymphoproliferative disease (PTLD), post LT malignancies. An algorithmic approach to post-LT Biliary complications is undertaken by ERCP or PTBD. International (7) and national (15) fellows had been trained on transplant hepatology till date. Training of manpower (Fellowship on transplant hepatology, transplant critical care and transplant immunology, transplant nursing and co-ordination), academic excellence, translational research (noninvasive methods for early detection of graft rejection, cell based therapy for steroid resistant rejection and immunoscan, etc.) and strategies to increase organ donation awareness, organ retrieval and promotion of cadaver transplant are in pipeline for the future.

 

K). Protocol based treatment

For patients with acute on chronic liver failure (ACLF), portal hypertension and variceal bleeding, hepatitis B and C and non-alcoholic steatohepatitis (Fatty liver disease), the department has been able to standardize the treatment protocols.

L). Patient support services

For patients with hepatitis B and C, and portal hypertension, highly skilled and trained nurses are now available to monitor the patient treatment and outcomes.

 

Liver Helpline

A dedicated 24 hour toll free no.1-800-11-5354 has been designated as “Liver Help Line” for the benefit of patient and their relatives. Questions related to liver diseases are answered round the clock by hospital emergency staff at this telephone number. Liver helpline also functions as telephone triage service and depending upon the urgency it helps patients and their relatives directed towards seeking appropriate level of health care.

Training and CME

Regular training programs are conducted for BLS and ACLS certification. Resident doctors, casualty medical officers, nurses and technicians have regular access to high quality clinical CMEs at the institute.

Services 2016 2017
Emergency care services 7650 8132
OPD services 53054 58987
ICU admissions 1180 1252
HDU admissions 1435 1567
Ward Admissions 3667 4304
Upper GI Endoscopy diagnostic 8093 8313
Colonoscopy diagnostic 1760 1812
ERCP 784 893
EUS diagnostic 550 574
EUS therapeutic 254 232
ESWL 27 23
Capsule endoscopy 34 21
Enteroscopy 81 54
Fibroscan 12457 13712
HVPG 1990 1772
TJLB 560 573
Cholangioscopy 7 11
Regeneration and stem cell therapy 69 65
Nutrition counselling 3646 4850
Body Composition Analysis 1113 914

New services & facilities

Fecal (Stool) Microbiota Transplantation (FMT) Unit

The human microbiota consists of trillions of microorganisms found in the human body, with the majority of organisms colonizing the gut from mouth to colon. A large number of diverse microbial species reside in the distal gastrointestinal tract, and gut microbiota dysbiosis (imbalances in the composition and function of these intestinal microbes) and excessive release of gut microbial products into the portal circulation has been implicated to have pivotal role in the development and progression of many of the liver diseases and their complications, most importantly - non-alcoholic steatohepatitis, alcoholic liver disease, alcoholic hepatitis, hepatic encephalopathy, sepsis in liver diseases etc. Globally, many efforts are currently concentrated on exploring potential possibility of exploiting the gut microbiome in the management of liver diseases. An improved understanding will fuel the conception and realization of novel therapeutic and preventive strategies. The gut microbiome (interaction between different microbes and their genes) contains 100 times as many genes as the whole human genome and hence is an important and less explored area in medicine. Fecal (stool) microbiota transplantation (FMT) involves acquiring healthy microbes from a related donor and then instilling these into the GI tract of the diseased individual. At ILBS, FMT is being used as a novel method in the treatment of severe alcoholic hepatitis, which otherwise is lethal nearly half, with limiting targetted therapeutic options other than liver transplantation. Earlier, we at ILBS have utilized FMT for the treatment of steroid ineligible responsive alcoholic hepatitis wherein the response has been encouraging with an improved survival. Lately we have initiated a trial where we intend to compare the effectiveness of FMT in comparison to steroids (which is the only approved option with its own side effects and limitations) in patients of severe alcoholic hepatitis. Up till now, more than 50 patients have been enrolled in the trial.

 

  • EUS guided gastric varix coil embolization: Large gastric varices may some time be difficult to manage using direct endocopic glue injection. EUS guided coil and glue injection in gastric varices is a safe and alternative procedure to Radiological procedures like BRTO and direct endoscopic glue injection.

EDUCATIONAL ACTIVITIES:

  • Institute of Liver and Biliary Sciences - Center for Research on Inflammation, INSERM, Paris (ILBS-CRI) Symposium March 29-30th, 2017
  • Workshop on Liver Diseases and Diabetes, Indo-French Perspectives, April 26th 2017
  • World Hepatitis Day - 2017: 28 July, 2017
  • Hepatitis Awareness Day: 4 Dec, 2017
  • Midterm INSCN Meeting 2017 of the Indian Society of Clinical Nutrition “Nutrition, Obesity and Metabolic Diseases-Current Perspectives and Challenges”, 29th November, 2017

 

Courses Offered

 
Names of the Course Candidates Admitted Candidates Passed
DM Hepatology: Admitted in 2016: Dr.Vinay Kumar, Dr.Rakesh Kumar, Dr Satyam, Dr Sushrut Dr.Vinod Arora, Dr Rajan V, Dr Sumeet Kaint, Dr Vikash Prakash
PhD Clinical Nutrition and PGCC Clinical Nutrition Ms. Harshita Tripathi (Ph.D) Ms. Harshita Tripathi (PGCC)
APASL School Hepatology: Trained in 2017 Total number of trainees- 5 Dr. Kamala Retnam Mayilvaganan, Ms. Khangemban Bijya Devi, Ms. Thangjam Surjalata Devi, Dr Nitin Yadav, Dr. Debi Prasad Ms. Harshita Tripathi (PGCC)

Department’s Achievements

Department Research activities: Department is actively involved in clinical as well as basic research in varied areas such as Portal hypertension, Viral hepatitis, Alcoholic liver diseases, Non alcoholic fatty liver disease, Acute Liver Failure, Acute on Chronic Liver Failure, Kidney injury in Liver diseases, Liver regeneration, Liver transplant. Department of hepatology has given important contributions to developing guidelines for treatment of various hepatological diseases like APASL guidelines for hepatitis B, hepatitis C, liver fibrosis, hepatocellular carcinoma, variceal bleed, non-cirrhotic portal hypertension, International ascites club guidelines for AKI in cirrhotics. Department is also involved in developing novel therapies for liver diseases like regeneration therapies of liver using growth factors, fecal microbiota therapy for severe alcoholic hepatitis, newer biomarkers for liver cancer, AKI etc.

 

Visiting faculty to the department in 2017

Name Institution/strong> Date of Visit
Dr. Moreshwar S Desai Baylor College of Medicine, Houston. TX. 26-01-2017
Prof. Akira Asao Kyushu University Hospital, Fukuoka, Japan 13-02-2017
Prof. Tamir Miloh Baylor College of Medicine, Houston, Texas, USA 03-03-2017
Dr. Scott L. Nyberg Mayo Clinic, USA 09-03-2017
Prof. Rakesh Kumar School of Medicine and Health Sciences George Washington University, Washington DC, 19-03-2017 to 22-03-2017
Prof. Gyongyi Szabo University of Massachusetts Medical School, USA 10-03-2017
Prof. Renato Monteiro, Directeur Center for Research on Inflammation, UMR 1149, Paris, France 29-03-2017 to 30-03-2017
Prof Richard Moreau, National (French) Institute of Health (Inserm), Paris, France 29-03-2017 to 30-03-2017
Prof S. Lotersztajn Institut National de la Sante et de la Recherche Medicale (INSERM), Paris, France 29-03-2017 to 30-03-2017
Prof. B Van Beers Institut National de la Sante et de la Recherche Médicale (INSERM), Paris, France 29-03-2017 to 30-03-2017
Prof. Maude Le Gall Centre de Recherche sur l’Inflammation(CRI) in Paris, France 29-03-2017 to 30-03-2017
Dr Marc Bulterys, Global Hepatitis Program, WHO HQ, Geneva 13-04-2017
Dr Yvan Hutin Global Hepatitis Program, WHO HQ, Geneva 13-04-2017
Dr. Thierry Damerval Deputy CEO, INSERM, Paris, France 26-04-2017
Dr. Richard Moreau INSERM, Paris, France 26-04-2017
Dr. Christophe Junot CEA, Paris, France 26-04-2017
Dr. Joel Dore INRA, Paris, France 26-04-2017
Dr. Sophie Lotersztajn Research Center on Inflammation, INSERM, Paris, France 26-04-2017
Prof. Valerie Paradis Research Center on Inflammation, INSERM, Paris, France 26-04-2017
Prof. Didier Samuel Physiopathogenesis and treatment of liver diseases, INSERM,Paris, France 26-04-2017
Prof. Mike Turner Head of Infeciton and Immunoiology Wellcome Trust, UK 27-04-2017
Prof Richard Moreau INSERM, Paris, France 04-07-2017 to 08-07-2017
Prof. Christian Brechot President, Institute Pasteru, Paris, France 09-07-2017 and 10-07-2017
Professor Margaret Hellard Burnet Institute, Australia 19-07-2017
Dr. Pratap C. Reddy Founder Chairman, Apollo 07-08-2017
Prof Shruti Mehta Johns Hopkins Bloomberg School of Public Health, Baltimore,USA 02-11-2017
Dr Sunil Suhas Solomon Johns Hopkins School of Medicine, Baltimore, USA 02-11-2017
Prof.Kenneth H. Buetow Faculty, ASU Center for Evolution, Medicine, and Public Health Arizona State University, US 09-11-2017
Prof. Christian Brechot President, Institute Pasteur, Paris, France 28-11-2017, 29-11-2017
Dr. Ranil Jayawardena Senior Lecturer and Consultant Clinical Nutritionist, , University Colombo, Sri Lanka 29-11-2017
Dr. Luciana B Sutanto Clinical Nutrition Specialist Lecturer- Medical Faculty Diponegoro University Semarang, Indonesia 29-11-2017
Prof. William Cushley International Dean, Eurasia & South Asia,Professor of Molecular Immunology, University of Glasgow,GLASGOW G12 8QQ,Scotland,UNITED KINGDOM 07-12-2017
Dr. Susrutha Kotwal, MD Johns Hopkins University School of MedicineJohns Hopkins Bayview Medical Center Division of Hospital Medicine Baltimore, MD 13-12-2017
Prof. Richard Moreau INSERM, Paris, France 15-12-2017-17-12-2017
Dr. Puneet Puri Virginia Commonwealth University, USA 18-12-2017-20-12-2017 22-12-2017-23-12-2017
 
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  • Acuteon
  • DORSO
  • NSI
  • HBSCE
  • NLDB

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