How referrals work
Dr. Mayank Agarwal is an interventional gastroenterologist (DM Gastroenterology, GIPMER 2019) practising at Hayat Hospital and Apollo Clinic, Ulubari in Guwahati, with monthly outreach OPDs in Dimapur, Hojai, Tinsukia and Dibrugarh. Patients come from all seven Northeast states, so the aim is to keep the trip short: reports are reviewed beforehand, and the consultation, tests and any procedure are planned together wherever clinically safe.
You can send a patient with a note, or send the reports first and ask a question. Both are welcome.
Cases that are a good fit
| Situation | Useful to send | What can be offered |
|---|---|---|
| Jaundice with suspected bile duct stone or cholangitis | LFT, INR, CBC, ultrasound, CT or MRCP if done; current antibiotics | ERCP with stone extraction, sphincterotomy, biliary drainage or stent. Unstable or septic patients should first go to the nearest emergency department — please call before transfer. |
| Obstructive jaundice or suspected pancreatic / biliary growth | CT or MRI films and reports, LFT, CA 19-9 if done before stenting | EUS with FNA/FNB for tissue; ERCP with stent when drainage is needed. Whether to stent first depends on the surgical plan — discussed with you and the surgeon. |
| Pancreatic cyst or mass, subepithelial lesion, chronic pancreatitis | CT, MRI/MRCP, previous endoscopy | EUS, with FNA/FNB where needed; ERCP or endotherapy for selected duct problems |
| Fatty liver, abnormal LFT, hepatitis B or C, cirrhosis | Ultrasound, LFT, platelets, HBsAg, anti-HCV, previous endoscopy | FIB-4 and FibroScan at Hayat and Apollo, Ulubari; varices screening; surveillance and treatment planning. See fatty liver & liver disease |
| GI bleeding, after stabilisation | Discharge summary, Hb trend, endoscopy report, medicines (NSAIDs, aspirin, anticoagulants) | Endoscopic haemostasis, variceal banding, H. pylori testing and prevention plan. See GI bleeding |
| Iron-deficiency anaemia of unclear cause | CBC, iron studies, diet and menstrual history | Gastroscopy and colonoscopy, coeliac serology |
| Dyspepsia, reflux, H. pylori, IBS, chronic diarrhoea or constipation, IBD | Previous endoscopy or colonoscopy, calprotectin, current medicines, duration of PPI use | Consultation, diagnostic endoscopy, and a stepwise plan. See acidity, GERD & IBS |
| Colonoscopy and polyps | Indication, prior reports and histopathology, antithrombotic therapy | Diagnostic and screening colonoscopy, polypectomy and EMR, surveillance planning. See preparation guide |
| Strictures and feeding access | Barium or CT, endoscopy report, histology | Dilation and stenting of the food pipe or bowel; PEG placement |
| Children with GI symptoms | Growth chart, previous tests, reports | Consultation and endoscopy where indicated |
| Second opinion | Outside reports, endoscopy images, histology slides or reports | Review of outside reports |
This is a guide, not a limit. If you are unsure whether a case is suitable, please ask.
Where each service is done
| Site | What is done | OPD hours |
|---|---|---|
| Hayat Hospital, Kahilipara | Full interventional unit: ERCP, EUS, therapeutic endoscopy, variceal banding, EMR, stricture dilation and stenting, PEG, inpatient care. Diagnostic endoscopy and FibroScan too. | Mon–Sat, 11 AM – 4 PM |
| Apollo Clinic, Ulubari | OPD consultation, diagnostic gastroscopy, colonoscopy and sigmoidoscopy, FibroScan. | Mon–Sat, 8–10 AM; Mon–Fri, 5–7 PM |
| Outreach OPDs | Consultation near the patient's home; procedures, if needed, are planned in Guwahati. | Dimapur (Eden Medical Centre) — 2nd Friday; Hojai (Prime Medical Centre) — 2nd Saturday; Tinsukia (Darpan Diagnostics) and Dibrugarh (Apeksha Hospital) — 3rd Saturday |
On outreach days the Guwahati OPD may not run, and outreach dates can shift occasionally — please confirm on WhatsApp before sending a patient. Most endoscopies and colonoscopies are done without sedation; sedation is available on request at Hayat Hospital.
What to send with the patient
- The question. One line on what you want answered (for example, "obstructive jaundice — cause and drainage?").
- Key history: duration, weight loss, alcohol, diabetes and its medicines (including GLP-1 agonists and SGLT2 inhibitors, which matter for procedures), prior abdominal surgery, and allergies.
- Antithrombotic medicines. Please do not stop aspirin, clopidogrel or anticoagulants given for stents, AF or valves before contacting us — the plan is coordinated with the treating cardiologist or physician.
- Recent tests: CBC, LFT, INR, creatinine, blood sugar, and virology if done. For procedures, an ECG and chest X-ray in older patients or those with heart or lung disease.
- Imaging: reports and films or a shared link for CT, MRI or MRCP — a report alone is often not enough to plan EUS or ERCP.
- Prior endoscopy and histopathology reports, with images or slides where they exist.
Want to discuss a patient before referring?
Call, or send a short message with the question you want answered, along with the key reports and scans on WhatsApp. For an unstable patient, the nearest emergency department comes first.
Emergencies
For an unstable or bleeding patient
- Stabilise first: airway, drip, blood if needed — and send to the nearest emergency department.
- In Guwahati, Hayat Hospital Emergency, Kahilipara can receive patients; please call before transfer so that the endoscopy team can be informed.
- For patients with fever and jaundice (possible cholangitis), early antibiotics and prompt drainage matter — please do not delay transfer for further tests.
Common questions
Which kinds of cases do you accept?
The full range of digestive and liver disease — from reflux, IBS and fatty liver to bile duct stones, pancreatic and biliary conditions, GI bleeding and cirrhosis. Procedures such as ERCP, EUS, therapeutic endoscopy and variceal banding are done at Hayat Hospital. If you are unsure whether a case is suitable, send the reports and ask.
Can I send reports before the patient arrives?
Yes, and it is preferred. Send the key reports and scans on WhatsApp with your question, so the visit, tests and any procedure can be planned in one trip.
Where are ERCP and EUS done?
At Hayat Hospital, Guwahati, which has the full interventional unit. Diagnostic endoscopy and FibroScan are available at Hayat and at Apollo Clinic, Ulubari.
What should I do for an unstable patient?
Stabilise and send to the nearest emergency department first. In Guwahati, Hayat Hospital Emergency at Kahilipara can receive patients; please call before transfer. Cholangitis and bleeding should not be delayed for further tests.
Do you see children?
Yes. Children are seen in the same clinic as adults.
Can you give a second opinion on outside reports?
Yes. Send the reports, endoscopy images and histopathology reports or slides, and they will be reviewed.
Can I stop aspirin or blood thinners before referring for a procedure?
Please do not stop them on your own. Stopping aspirin, clopidogrel or anticoagulants given for stents, atrial fibrillation or valves carries its own risk. The plan is coordinated with the treating cardiologist or physician.
Related
Written and medically reviewed by Dr. Mayank Agarwal, MBBS, MD (Medicine), DM (Gastroenterology) · Assam Medical Council Reg. No. 19633 · Last reviewed:
This page is for medical professionals and describes how referrals are handled. It is not medical advice for patients.
Based on:
- Kiriyama S, et al. Tokyo Guidelines 2018: diagnostic criteria and severity grading of acute cholangitis. J Hepatobiliary Pancreat Sci 2018;25:17–30. PMID 29032610.
- Dumonceau JM, et al. Endoscopic biliary stenting: indications, choice of stents, and results — ESGE Clinical Guideline, updated October 2017. Endoscopy 2018;50:910–930.
- Veitch AM, et al. Endoscopy in patients on antiplatelet or anticoagulant therapy, including direct oral anticoagulants: BSG/ESGE guideline update. Gut 2021;70:1611–1628.
- European Association for the Study of the Liver. EASL Clinical Practice Guidelines on non-invasive tests for evaluation of liver disease severity and prognosis — 2021 update. J Hepatol 2021;75:659–689. PMID 34166721.
- de Franchis R, et al. Baveno VII — Renewing consensus in portal hypertension. J Hepatol 2022;76:959–974.