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Dr. (Colonel) Avnish Seth

Head, Department of Gastroenterology & Hepatology at Manipal Hospital, Dwarka, New Delhi.

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Organ Donation

Happy to share a first for us at Manipal Hospital Delhi on 30th November: Endoscopic Ultrasound (EUS) guided Choledocho-Duodenostomy for relief of malignant biliary obstruction. Mr SL, 68 years, was hospitalized with us for obstructive jaundice and cholangitis. Evaluation revealed growth in head of pancreas with liver mets. EUS Guided FNA with ROSE ( Rapid Onsite Evaluation) by pathologist confirmed Adenocarcinoma pancreas. At ERCP the guide-wire could not be negotiated proximal to the growth in pancreas. Such patients with failed ERCP are normally referred worldwide for PTBD(percutaneous trans-hepatic biliary drainage). We decided, instead, to access the bile duct, proximal to the obstruction, from the duodenum(D1) and with EUS guidance, place a Lumen Apposing Metal Stent(LAMS), thus establishing biliary drainage into duodenum. Procedure time was under 15 minutes and the patient is doing well.


The proximal end of the stent in dilated bile duct


Purulent bile pouring out from distal end of stent in duodenum, about 5 cm proximal to the normal opening of bile duct in Ampulla of Vater

Landmark published work in field of Gastroenterology, liver disease & transplantation

Organ Donation

Call (+91)-9650986896, +91-7840064694 -or- dravnishseth@gmail.com
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