When to consider referral
| Area | Typical indications |
|---|---|
| ERCP | CBD stones (confirmed or high probability), obstructive jaundice, cholangitis, bile leak, biliary stricture, stent exchange |
| EUS / EUS-FNB | Pancreatic mass or cyst, intermediate probability of CBD stones, idiopathic recurrent pancreatitis, subepithelial lesions, staging, mediastinal or abdominal lymph nodes |
| Therapeutic EUS | Symptomatic or infected pseudocyst / WON, failed ERCP biliary drainage, gastric outlet obstruction, pancreatic pain needing coeliac block |
| POEM | Manometry-confirmed achalasia (all types), failed prior dilatation or Heller myotomy, selected spastic disorders |
| Colonoscopy / EMR | Large or complex polyps referred for surgery, positive FIT, rectal bleeding, iron-deficiency anaemia |
| Therapeutic endoscopy | Upper GI bleeding, varices, refractory strictures, malignant obstruction needing stents, foreign bodies, PEG |
Urgent referrals
Acute cholangitis, severe gallstone pancreatitis with cholangitis, major GI bleeding or a food bolus: please send the patient to the emergency department and inform the hospital's emergency team. Don't wait for an OPD slot.
What to send with the patient
- A short referral note with the question you'd like answered
- Recent blood tests (LFT, CBC, INR, creatinine, lipase)
- Imaging reports and images (CD or link)
- Previous endoscopy, ERCP or EUS reports and pathology
- Anticoagulant and antiplatelet details
Case discussion
Happy to discuss difficult cases by phone or in person through the hospital, or by email at info@balajigastro.com. Patient information is shared only with consent and in line with data-protection law.
Teaching
I take part in CMEs and teaching on pancreatobiliary disease and therapeutic endoscopy.