Wonderful overview by @jpgurria of #tpiat and @MaisamHaijaMD of #pancreatitis today in Cancun! Great to see old and new friends!

Great opportunity to connect with our #pancreas colleagues in Mexico! @jpgurria @MaisamHaijaMD

RT @jpgurria: We had a Wonderful time in Lexington thanks @KCHKids for hosting us @CincyKidsGastro @CincyKidsSurg let’s change the outcome…

@DannyIssaMD @ASGEendoscopy Unfortunately we are stuck using the discontinued @Olympus_Corp JF duodenoscope in children this size. In pts <10kg we use the also discontinued PJF scope, which is very limited with a 2.0 mm working channel. We need a new, small caliber duodenoscope from industry ASAP

@temarahajjat @ASGEendoscopy Small PD in this 3 yo, a little over 1mm, can be a real challenge to have proper sized dilating catheters, etc in the smaller children. The second image shows placement of a PD stent across the stricture, hoping he will respond clinically with less frequent AP episodes!

@deslilo @PedsGIChat @CincyChildrens @CincyKidsRad @AndrewTroutMD We still need to go to #EUS sometimes when the MR images are still inconclusive, or the pts labs are concerning and don't correlate well with negative imaging. Of course - straight to #ERCP still happens when the abd US and/or labs are conclusive.

@PedsGIChat Thank you again for having me tonight @PedsGIChat @KevinWatsonJrMD. #ERCP , #EUS and interventional GI will continue to grow in peds to offer pts less invasive management for GI disease. Look forward to seeing everyone at @NASPGHAN in San Diego in October!

@PedsGIChat @NASPGHAN There is a fellowship match with @ASGEendoscopy (adult endo), which some pediatric fellows have now started applying through. Identifying a plan (where will you be as a faculty and what are your goals there?) ahead of the application will be very helpful!

@PedsGIChat This one stumped me. I googled it, @nasphgan’d it and there is no directory I can find. We need to work on compiling something within our #ERCP significant interest group to publish on @naspghan. In the meantime, ask around to colleagues and reach out to any of us – anytime!

@PedsGIChat No. We are somewhat limited in what can be accomplished in small children due to endoscope and accessory limitations, but there are really no absolute contraindications.

@PedsGIChat SOD 1 or 2 are diagnosed based on elevated LFTs and/or dilated CBD post chole AND typical biliary colic pain. In those select pts, ERCP with biliary sphincterotomy is indicated, but pts need to be counseled about their higher risk of post ERCP pancreatitis.

@PedsGIChat @JasonFrischerMD @Aaronpgarrison @BethRymeski @nelson_rosen Other indications include rectal subepithelial lesions (looking at you, neuroendocrine tumor), EUS guided anal botox (, therapeutic intervention for fluid collection or abscess.

@PedsGIChat I am spoiled @CincyChildrens. Our amazing @CincyKidsRad team and @AndrewTroutMD developed a rapid protocol MRCP (no sedation if young!) to look for CBD stones. We can get it in the ED, which helps our decision making and sometimes avoids unnecessary sedation for EUS and/or ERCP.

@PedsGIChat @NASPGHAN @david_troendle Relevant example: 14 year old girl presented to me with severe RUQ colicky pain x 2 months. Normal abd US x 2, normal MRCP, normal CT scan and RUQ colicky pain. GB stone was found on EUS but missed in all other imaging modalities. #EUS #endoscopy #medtwitter