Dr. Lars Aabakken, WEO President: "WEO appreciates the work done in democratizing advanced gastrointestinal care in all corners of the world and congratulations to the team and the Institute in achieving CORE recognition."
On 15 May 2023, the Sindh Institute of Advanced Endoscopy and Gastroenterology (SIAG) opened in Karachi, Pakistan, with a simple premise: advanced endoscopy and gastroenterology care, delivered free of charge, without compromising quality. Funded through a public–private partnership, SIAG was recently recognized by the World Endoscopy Organization under its Collaboration of Organized and Recognized Endoscopy units (CORE) program.
Led by Dr. Saad Khalid Niaz, who brings over 30 years of advanced endoscopy experience, the unit's interventional portfolio includes EUS, peroral cholangioscopy, and peroral endoscopic myotomy (POEM0, alongside the only dedicated extracorporeal shock wave lithotripsy (ESWL) service for pancreatic ductal stones in Pakistan, which draws referrals from across the country. Every procedure, laboratory test, biopsy, and medicine – including pre- and intraprocedural drugs – is provided at no cost to the patient.
About SIAG
The center began in 2006 as a three-room setup in Surgical Unit IV of Civil Hospital, Karachi, where endoscopy, colonoscopy, ERCP, and EUS were performed free of charge. That service grew into the fully independent unit now known as SIAG, guided by the motto “Quality care with respect.”
Free care is not improvised care. The unit operates a dedicated scope decontamination and reprocessing facility, maintains structured telephone follow-up at 24 hours and 7 days after every procedure, and provides complimentary toys for its pediatric patients.
Three years in numbers
Procedure volumes since opening reflect both the scale of unmet need in the region and the growth of the service:
Patient safety during these complex, high-volume interventions is supported by a dedicated in-house anesthesia department, with six qualified anesthetists present at all times.
Beyond luminal endoscopy
SIAG operates as a comprehensive gastroenterology and motility service rather than a purely endoscopic one. Alongside standard and advanced endoscopy, the unit performs high-resolution esophageal and anorectal manometry, pH monitoring, diagnostic ultrasound, fibroscan, pigtail catheter insertion, and ultrasound-guided percutaneous transhepatic cholangiography (PTC).
Care is organized around dedicated subspecialty clinics — pancreatic disease, inflammatory bowel disease (IBD), obesity, and oncology — where patients are managed longitudinally, with free laboratory testing and medicines extended into these clinics.
Research, training, and recognition
SIAG is recognized by Pakistan's Drug Regulatory Authority (DRAP) as a clinical trials site and houses a dedicated research, innovation, and AI unit that has produced 14 peer-reviewed publications to date. As a regional training hub, the center has hosted 17 colonoscopy, 8 ERCP, and 6 EUS workshops with national and international faculty, along with 6 “Train the trainers” sessions, and has developed 8 proprietary training simulators. One-year core training programs in anesthesia technology and endoscopy technology, recognized by the Sindh Faculty Board, strengthen the allied health workforce.
Why this matters beyond SIAG
We share these numbers because we believe the experience is replicable. Free-of-charge, comprehensive advanced endoscopy and gastroenterology, delivered at volume with structured follow-up in a lower/middle-income country, remains unusual, and the model may hold lessons for other centers working under similar resource constraints. Three years in, SIAG continues to treat "free of charge" and "world-class" as compatible, not competing, goals.
We are grateful to the World Endoscopy Organization for recognizing SIAG within CORE and look forward to contributing to the community of centers working toward the same end: access to quality advanced endoscopic care based on need, not means.
Dr. Abeer Altaf, Junior Consultant, Advanced Endoscopy and GI Motility at SIAG, and Muhammad Umair Tahseen, Resident Medical Officer at SIAG.
Sindh Institute of Advanced Endoscopy and Gastroenterology (SIAG), Karachi, Pakistan Mission Rd, New Labour Colony, Adhumal Oodharam Quarter, Karachi, 74400
