Gastric cancer is associated w/ significant morbidity and mortality.
A very fortunate patient with early gastric cancer T1 on EUS was referred for ESD. Fortunately for him lesion was T1a on final path!
@PittGILiverNutr
#gitwitter
A perfect “cast” of the bile duct in a post transplant pt. Pulled out during ERCP. This was rather soft
How often do you see that ?
#advancedendo
#ercp
#gitwitter
Congratulations 🎉 to my lovely wife
@SultanRutaba
on her IM residency graduation 👩🎓!
Really proud of you. You will be an excellent physician.
@UBIMResidency
Excited to officially launch the 3rd space program at
@PittGILiverNutr
!
12 cm LSL removed en bloc, covering 75% circumference.
Apologize for the poor quality pics . 🎥 recording got messed up.
#gitwitter
Thrilled to share that we’ve completed over 50 POEM procedures this week at
@PittGILiverNutr
and established a strong ESD program. It truly takes a village—I’m incredibly grateful to my mentors, colleagues, reps and the outstanding team at
@UPMC
for their unwavering support.
🥳We are thrilled to welcome
@SultanMahmoodMD
to the
@UPMC
Interventional Endoscopy Team! We now offer ESD and POEM to patients at
@UPMC
Passavant, enhancing our commitment to exceptional patient care. 📢Learn more:
@UPMC_CTSurgery
Couldn’t have asked for a better team to spend the last year with. Learned so much in addition to the procedural skills and made some life long friends and mentors!
@BIDMC_GI
Hopeful the GI community will find this focused article helpful in framing their approach to improving the quality and value of screening colonoscopy at their institutions (including us at
@NMGastro
!) See full article at
#Gitwitter
need your help with this case.
Pt with dysphagia (LES stric), large epiphrenic diverticulum (no achalasia) coming in for dilation. EGD with a large impacted piece of plastic. Dilated LES to 20mm. Unable to push it through to the stomach or retrieve it through UES💡
📢REMSWITCH paper is out on
@AGA_CGH
!
Switching from IV to sQ infliximab is safe and well-accepted.
Good option for patients with potential cost saving?
#gitwitter
#mondaynightibd
🔗
A very satisfying case at
@BIDMC_GI
#advancedendo
🩺Young lady post whipple for ABPJ with abdominal pain found to have abnormal liver enzymes/ LHD stone on MRCP.
ERCP with stone at HepatoJ and LHD. CBD was big enough to allow passage of PCF for CHOLANGIOSCOPY 🤯
Heartiest congratulations to our incoming 2022 BIDMC advanced endoscopy fellows:
@iamdriggy
,
@EHolzwanger
, and
@SultanMahmoodMD
. We are all looking forward to help you get launched as colleagues and collaborators in such an exciting field.
Multidisciplinary coordination is the 🔑 to a successful advanced endoscopy program.
Combined procedure with interventional cardiology 🫀 , thoracic surgery 🫁 and interventional Gi 💩to manage a complex pt.
Any guesses what we are did?
Hint: pt failed endosuturing/otsc
Patient with severe CBD stricture caused by panc head mass. Failed ERCP. Proceeded with EUS cholecystoduodenostomy. Stent placed successfully but only clear fluid could be seen coming through the stent?
What is going on here?
@EHolzwanger
@tberzin
@ChahalPrabhleen
Hybrid ESD can be a great rescue option for scarred-down polyps and difficult locations. Important to get a good circumferential dissection to bury the snare.
Unfortunately, this polyp came back as invasive cancer with high-risk features so the patient eventually needed surgery
🔥Exciting new study from
@teoh_anthony
et al
👉EUS – guided choledocho-duodenostomy a reasonable first choice option for patients with unresectable malignant distal biliary obstruction
@AGA_CGH
@AGA_Gastro
#gitwitter
🔗
62 yo F w/ diarrhea. labs with AKI, high CRP, ANCA, negative infectious workup. started on steroids but returns later with hemoptysis.
Unifying etiology?
🔗
As the graduation day approaches, I was thinking about compiling
"Tips for Graduating GI fellows ".
I will start with one
1) Write name of snare, peg tube, hemoclips that you like . Makes it easier to request it at your new job.
@ZachSmithGI
@ChahalPrabhleen
@MTPapaD
An excellent review on the role of antireflux surgery published in
@AGA_CGH
by Vivek Kaul.
10 things every Gastroenterologist should know.
🤯"A total of 82.6% of patients resume their original PPI prescription within 15 years of antireflux surg"
Let the "intermittent fasting" begin.
Happy Ramadan to all my friends celebrating. Let's take a moment to count our blessings and thank 🙏 all our family and friends.
Pt coming in for ercp with CBD stricture 2/2 metastatic pancreatic cancer. Found to have a moderate duodenal stricture, ercp scope could traverse .
JF-140 scope to the rescue, procedure completed safely without the need for dilation or ptbd. Anyone have this scope ?
#gitwitter
Thought provoking article from
@AGA_CGH
“Up-front endoscopy maximizes cost-effectiveness and cost-satisfaction in uninvestigated dyspepsia”
Early endoscopy for dyspepsia a reasonable approach ?
🔗
3/4
➡️Using this misnomer leads to unnecessary focus on anti inflx medication which are unlikely to work
➡️We suggest using the more appropriate term Radiation associated vascular ectasias (RAVE) for all vascular ectasias seen after ch. RT.
#gitwitter
#ddw2022
taking 6 biopsies instead of 4 doubles the yield of Celiac disease.
In bulb highest yield is at the “dependent area” at 9 and 12oclock position
@ASGEendoscopy
3rd RCT on Ac uncomplicated diverticulitis fails to show any benefit of antibiotics.
@AGA_CGH
👉Multi-center placebo controlled trial
👉180 pts randomized
👉Hospital stay (A40.0 vs P45.8hrs)
👉Ad events (A12% vs P12%)
👉Readmission 7d/30d (not diff)
Congratulations
@shailsingh
@ShyamTMD
on a successful WISE interventional endoscopy conference near Pittsburgh !
Excellent faculty and live cases.
Great opportunity to connect with friends and colleagues.
We see you back there
@SighPichamol
🤣
Patient with a h/o cholelithiasis comes in with abdominal pain , labs show T bili 3.8, mild elevation in AST ALT AP, Liver US with dilated CBD at 1 cm. MRCP is obtained and reported -ive. However, after 3 days T bili remains elevated at 3.4.
DOI: 10.1016/j.cgh.2019.10.035
Positioning therapies for Crohns disease published in
@AGA_CGH
@AmerGastroAssn
.
Haven't used Sulafalazine for CD but seems to be a reasonable option for low risk patients with colon dominant disease.
@DCharabaty
@IBD_Afzali
@ibdtweets
Excited to moderate the
@SAGES_Updates
Flexible Endoscopy course 2021! . Good to see in person educational activities resuming.
Also got to meet the amazing
#Vivekkaul
!
Doesn’t matter how busy it gets, still time for a morning didactic session !
Did you know that the first cholagiopancreaticogram was performed by a radiologist at
@BIDMC_GI
. Imagine cannulating the ampulla using just flouro 🤯
#gitwitter
6/ BIDMC has a rich history in advanced endo w/ a long list of ‘1sts’, including 1st per-oral cannulation with cholangiography (by two radiologists at Beth Israel in 1965!), to more recently the 1st Spyglass digital cholangioscopy & 1st deep learning AI colonoscopy in U.S.
An important study in
@AGA_Gastro
by Dr Rex addressed the benefit of AI in high detecting (~50% ADR) endoscopists. They still saw a 8% increase in ADR to a 🤯 60.6%
Interestingly some large lesions especially SSLs were missed by AI software. Room for improvement?
#Gitwitter
Higher induction regimen (adalimumab 160 mg at weeks 0, 1, 2, and 3) was not superior to standard induction regimen in patients with moderate to severe CD.
SERENE CD Trial Results
🔗
@AmerGastroAssn
@AGA_Gastro
#gitwitter
#meded
Gene therapy has the potential to revolutionize modern medicine. Gastroenterology and especially Hepatology will likely see a number of applications in the coming years.
Really enjoyed reading this article from
@AGA_Gastro
#gitwitter
@AGA_CGH
EGD for dyspepsia in a 50 y/o female shows this lesion in D2, ~1cm flat polyp. What would you do?
#polypthursday
1. remove w/lift snare
2. biopsy and decide based on path
3. no biopsy, reschedule to remove lesion
You get a referral from an OSH for a failed colonoscopy because of a "tortuous colon". A pediatric colonoscope was used during the failed procedure.
What scope do you start off with?
#gitwitter
#gifellows
1/2 AGA
@AGA_Gastro
CPU on management of recurrent ac and ch pancreatitis
👉workup Rec AP➡️EUS > MRI/MRCP
👉❓role of ERCP in divism. Minor ✂️ dilated dorsal PD, santorinicele
👉🛑ERCP in rec ac pancreatitis. ❓biliary sph ✂️
@elmunzer
@DennisYangMD
🔗
👉In the real-world setting, Ustekinumab dose escalation was effective in achieving response in CD pts ( 55% of pts w/ inadequate response or loss of response)
@GiJournal
@AGA_CGH
@AGA_GIHN
#gitwitter
🔗
#GItwitter
any tricks to get this migrated PD stent out? 4cm x 5 single pigtail stent . There is a 5F 11mm extraction balloon alongside it to give an idea bout the trajectory of PD. Couldn’t pull it out with an extraction balloon. Forceps wouldn’t make the turn.
📢We are planning a combined journal club with
@GIPathJC
on May 12th
@8pm
EST! We will have an all ⭐️panel of GI Pathologists as experts and our very own
@GI_Pearls
will be moderating the session.
If you have any articles/ clinical Qs you would like to discuss, let us know
Impressive improvement in need for 🔪 in patients with IBD since 2000.
Can largely be attributed to the availability of better medications and treat to target approach.
@AGA_CGH
@AmerGastroAssn
If you are a
#GIfellow
learning colonoscopy or an academic attending assessing colonoscopy skills, please join the conversation this Wednesday on
@GiJournal
#GIjc
. This would be a nice fup from
@ScopingSundays
discussion on difficult colons.
Really enjoyed the company, food and CME session at the annual
@KEMCAANA1
retreat. Got a chance to talk about social media for
#MedEd
Helped setup Twitter account for some our senior members too 😁
Thanks
@TomTielleman
and
@BilalMohammadMD
for sharing your presentations.
Resistance testing for H pylori on stool samples as good as gastric samples using NGS.
Was listening to the podcast with Dr Graham and
@JonathanBuscag1
Makes sense to do this upfront on all cases and limit💊 use
#gitwitter
@AGA_Gastro
My daughter after getting training wheels off yesterday had been looking at BMX stunt videos on YouTube..
Kind of reminds me of first year fellows after their first polypectomy looking at ERCP videos.
#GIfellows
#meded
Excellent case with
@MoamenGabrMD
@BIDMC_GI
Large ascending colon polyp covering 75% of the circumference (7cm x 4 cm). Tattoo at the base from the previous colonoscopy.
✂️EMR with aid of Dilumen device.
📎Closed with
@bostonsci
mantis clips.
#gitwitter
Delaying colonoscopy more than 12 months after a + FIT test associated with increased CRC risk.
Especially important considering hesitancy to undergo colonoscopy during COVID. Time to educate patients and PCPs
@AGA_Gastro
@samirguptaGI
@drfolamay
DOI: