Pancreatico-Biliary Center of Excellence
Pancreas & Biliary Conditions
Expert tertiary care for Acute & Chronic Pancreatitis, Pancreatic Cysts, Pseudocysts, and Obstructive Biliary Diseases with Dr. Randeep Rana.
Advanced ERCPCBD Stone & Biliary Stenting
Linear EUSHigh-Resolution Pancreatic Imaging
LAMS ProtocolCystogastrostomy Pseudocyst Drainage
PERT TherapyPancreatic Enzyme Optimization
Jump To Heading:Acute PancreatitisChronic PancreatitisPancreatic Tumors & CystsPancreatic Pseudocysts & Walled-Off Necrosis
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Acute Pancreatitis
Sudden, acute inflammation of the pancreas usually triggered by gallstones or heavy alcohol use, requiring urgent hospitalization and evidence-based stabilization.
Symptoms & Warning Signs
- Severe, sudden epigastric pain radiating directly to the back
- Pain aggravated after eating and leaning backwards
- Persistent nausea, intractable vomiting, and abdominal distension
- Tachycardia, low blood pressure, and fever in severe cases
Diagnostic Workup
- Serum Lipase and Amylase (elevated >3 times upper normal limit)
- Contrast-Enhanced CT Abdomen (CECT) to assess necrosis (Balthazar score)
- Abdominal ultrasound and MRCP to detect gallstone etiology
Treatment & Protocol
- Goal-directed IV fluid hydration and multimodal analgesia
- Urgent therapeutic ERCP within 24-48 hours if biliary obstruction/cholangitis is present
- Early oral/enteral feeding as soon as ileus resolves
Protocol curated by Dr. Randeep Rana(AIIMS & PGIMER Trained, Max Smart Hospital)
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Chronic Pancreatitis
Irreversible structural destruction of the pancreas characterized by calcifications, ductal strictures, debilitating chronic pain, exocrine insufficiency, and diabetes.
Symptoms & Warning Signs
- Recurrent, constant dull upper abdominal pain radiating to the spine
- Steatorrhea: oily, foul-smelling stools that float and are hard to flush
- Weight loss despite adequate appetite due to maldigestion
- Onset of Type 3c pancreatogenic diabetes
Diagnostic Workup
- Endoscopic Ultrasound (EUS) — Gold standard for early parenchymal changes
- MRCP with secretin enhancement to evaluate pancreatic duct anatomy
- Fecal Elastase-1 test to quantify exocrine pancreatic insufficiency
Treatment & Protocol
- Pancreatic Enzyme Replacement Therapy (PERT) tailored to meal fat content
- Evidence-based pain management including pregabalin-based neural pathways
- Endoscopic pancreatic duct stone extraction and stenting via ERCP
- EUS-guided celiac plexus block for refractory chronic abdominal pain
Protocol curated by Dr. Randeep Rana(AIIMS & PGIMER Trained, Max Smart Hospital)
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Pancreatic Tumors & Cysts
Pancreatic cystic lesions (IPMN, MCN, serous cystadenomas) and solid tumors requiring high-resolution characterization to determine malignant potential.
Symptoms & Warning Signs
- Often discovered incidentally on abdominal scans for unrelated reasons
- Painless obstructive jaundice (yellow eyes, itching, dark urine)
- Unexplained new-onset diabetes in older adults without family history
- Mid-epigastric back pain and unintentional weight loss
Diagnostic Workup
- Linear Endoscopic Ultrasound (EUS) with Fine Needle Biopsy (FNB)
- Cyst fluid aspiration analysis (CEA level, Amylase, Glucose, Cytology)
- Pancreatic protocol triphasic dynamic CT / MRI
Treatment & Protocol
- Regular EUS/MRI surveillance protocols for low-risk mucinous cysts (IPMN)
- Multidisciplinary tumor board evaluation for surgical resection (Whipple procedure)
- Endoscopic palliative biliary and duodenal stenting for advanced lesions
Protocol curated by Dr. Randeep Rana(AIIMS & PGIMER Trained, Max Smart Hospital)
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Pancreatic Pseudocysts & Walled-Off Necrosis (WON)
Encapsulated fluid or necrotic collections forming around the pancreas following severe pancreatitis episodes, successfully drained endoscopically without open surgery.
Symptoms & Warning Signs
- Persistent abdominal fullness, early satiety, and gastric outlet obstruction
- Persistent low-grade fever or infection of the fluid collection
- Continuous upper belly pain and nausea
Diagnostic Workup
- Endoscopic Ultrasound (EUS) to measure wall thickness and vascular proximity
- Contrast-Enhanced CT / MRI Abdomen
Treatment & Protocol
- EUS-Guided Cystogastrostomy using plastic double-pigtail stents
- Lumen-Apposing Metal Stents (LAMS) with direct endoscopic necrosectomy (DEN)
- 100% non-surgical resolution with rapid outpatient recovery
Protocol curated by Dr. Randeep Rana(AIIMS & PGIMER Trained, Max Smart Hospital)
Max Smart Super Speciality Hospital, Saket, New Delhi
Take the First Step Towards Digestive Wellness
Consultant Gastroenterologist, Hepatologist & advanced endoscopist at Max Smart Saket