Therapeutic endoscopy dramatically changed with the addition of echoendosonography 🔥
First radial echoendoscope was designed by
@Olympus_Corp
and utilized in Tokyo in 1982
We all ❤️EUS, so let's talk about 4 stations to help guide with anatomy
#GITwitter
#MedTwitter
#MedEd
I am incredibly honored and blessed to be doing my advanced endoscopy fellowship
@BIDMC_GI
! I am eternally grateful to my family, friends and mentors and look forward to joining the therapeutic endoscopy family!
#advancedendoscopy
April is
#esophagealcancerawarenessmonth
Esophageal cancer is a lethal malignancy that affects many families each year worldwide. It is usually difficult for me to talk about my family history, however I find it imperative to raise awareness. Here is my family’s story 🧵
The path was not an easy one, especially starting out with losing my father as a teenager, but I am so grateful to my friends, family and mentors for their endless support to get me to my goal! Excited to announce I will be joining
@TuftsMedicalCtr
as advanced endoscopy faculty!
Feeling a little extra fortunate today.
I’m so grateful to have been apart of the
@TuftsMedicalCtr
family and couldn’t have asked for better training!
Huge shoutout to all of my family, friends, mentors because my dreams would never come to fruition without all of your support!
Reflecting this week on 1 year
@TuftsMedicalCtr
and I’m so proud of what we accomplished
Started a third space endoscopy program, bariatric endoscopy program and an advanced endoscopy fellowship
Advanced endoscopy volume has multiplied x 10 from a year ago
Thanks to: 🧵
So excited to announce a huge step forward for the
@TuftsMedicalCtr
Division of Gastroenterology/Hepatology where I have been approved to start an advanced endoscopy fellowship!
Keep your 👀out for our 1st AEF
@MikeTalanian
as he is a rising ⭐️
@TuftsMedSchool
@TuftsMedSchool
Living life on the
#edge
with
@tberzin
🦪 The Sand Dollar Sign during EUS directed transgastric ERCP
🦪 Understanding RYGB anatomy is critical
🦪 Remnant stomach (not in all cases) gives sand dollar appearance
🦪Aim for Axios placement
#GITwitter
#MedTwitter
#MedEd
⭐️Gastrocutaneous Fistulas⭐️
🔴Uncommon, late complication of PEG tube removals or other gastric surgeries
➡️ skin irritation/recurrent skin infections/⬇️QOL
🔴May be difficult to treat endoscopically (APC, TTSC/OTSC, X-Tack, Suturing)
In honor of
#ColorectalCancerAwarenessMonth
I wanted to post how far
#GI
has come with endoluminal surgery and the amazing options we have for patients
⤵️ Rectal ESD (R0 en bloc resection➡️TVA with extensive HGD) ➡️ curative and 🤞will prevent cancer
#GITwitter
#MedEd
📣Meet Erik Holzwanger! (
@hilarholzy
)
👨⚕️Director of Endoluminal Surgery and Bariatric Endoscopy; Program Director, Advanced Endoscopy Fellowship; Assistant Professor of Medicine, Tufts Medical Center; and former TIGE Fellow.
⭐TIGE's New Social Media Editor!
Our Board of Editors, editorial staff, and publisher met today to discuss the past year's progress as well as the strategic direction of the Journal moving forward!
Getting posters accepted to conferences is an accomplishment, but being able to mentor and watch the growth of your colleagues is truly where the reward is. Congratulations to all those who had posters accepted to
#ACG2021
!
Humbled to be awarded the “ACG Outstanding Poster Presenter Award” for our work “Benchmarking false positive definitions for computer-aided polyp detection in colonoscopy”
#ACG2020
#AIinGI
Grateful to my incredible mentors
@BilalMohammadMD
@tberzin
⭐️Important example of why to ERCP dominant strictures in PSC⭐️
28 y/o panUC transferred for 📈LFTs with MRCP revealing PSC changes and dominant distal CBD stricture.
👀Cholangiogram and Brushings below (30 brushes back and forth is 🗝️)
#GITwitter
#MedEd
@Taalamri
@docdhir
🧰EUS Guided Rendezvous ERCP
🔥Great for unusual papillas (inability to identify/cannulate) + dilated CBD
💡19g FNA 🪡, 450 guidewire (straight or angled depending)
💡Ideal position 🪡 parallel to CBD
💡Cannulate next to wire or backload wire with tome
#GITwitter
#MedEd
@docdhir
Been truly an amazing 2 weeks of complex procedures and working with an amazing endo/anesthesia team
@TuftsMedicalCtr
First research meeting with these rising 🌟 and excited to see their careers continue to 🚀
We will be ready to collab soon 😊
#GITwitter
@surya_khadilkar
Grateful for the endless support from my ⭐️ PD
@RKaragozian
and my mentors!Thrilled to be attending the
@AmerGastroAssn
Tech Summit and looking forward to meet with all the great innovators in the field and learn about novel developments!
@TuftsMedicalCtr
@TuftsMedSchool
Congratulations to
@TuftsMedicalCtr
3rd year GI fellow
@EHolzwanger
for being selected to participate in the
@AmerGastroAssn
Innovation program
#AGATech
#AGACGIT
An excellent opportunity to meet with tech leaders, industry execs,thought leaders about the latest innovations in GI
🏁Time to pop into the duodenal bulb!
🏁Big wheel slightly away and 👀 a big 🩸vessel ➡️ Portal Vein
🏁Track the PV down and see the portal confluence: SV ➕ SMV
🏁Above the confluence ➡️ head of pancreas and CBD above PD
For those just starting to learn about EUS, I hope this was a nice introduction! When in doubt, always remember your stations and practice makes perfect! 😊
Image references:
1.
2.
3.
Significant duodenitis and anatomical variations can be challenging for ERCP 😡
🗝️: Breathe 🫁 and move forward
This case took time to find the ampulla in D2/D3 junction under a hood surrounded by inflammation in a less conventional ERCP position
#GITwitter
#MedEd
@Taalamri
Shining 💡 on various modalities of treatment during
#EsophagealCancerAwarenessMonth
❄️Cryotherapy❄️ ➡️ BE-related neoplasia
⭐️Liquid nitrogen (-196C, deeper mucosal penetration)
⭐️Helpful for BE/IMCA resistant to RFA
⭐️Can be used for early EAC (e.g. 🚫 surgical candidates)
EGD with a cap can be your friend! 👀out how this became successful
EGD with cap to major papilla (can only use <7Fr equipment)▶️cannulate PD/PD stent▶️needle knife over PD stent (careful movements with big wheel as no elevator)▶️sphincterotomy and stones out!
@GI_Guy
@docdhir
Words can’t describe the amazing
@PopovVioleta
and how grateful I am to have spent the past month learning medical and endoscopic management of obesity! Excited to work together in the future!
🔥Pancreatic Duct Work🔥
Patient with PD leak s/p PD stent and CBD stent referred for removal of stents and reevaluation
👀Images below
Initial attempt with rat tooth, spybasket, sweeping balloon failed ▶️cholangioscopy with spybite for removal
#GITwitter
#MedEd
@bostonsci
Tried out new
@bostonsci
AcquireS FNB 🪡 and have to say it is 🔥
🔥📈 visualization of needle
🔥Large amount of tissue
👀below pancreas mass sampled with slow pull technique:🦈 vs AcquireS (2 sticks with 10 actuations each)
1st image AcquireS/2nd 🦈/Path
#GITwitter
#MedEd
🚩Tough Case Alert🚩
46 y/o F hx intrahepatic cholangiocarcinoma found to be unresectable due to peritoneal mets during attempted resection s/p chemoradiotherapy now s/p IR drains and trilateral uncovered metal biliary stenting...
Incredible discussion about diagnosis and management of OIED and EGJOO by our visiting professor, Dr. Vela of
@MayoClinicGIHep
Increasing incidence of EGJOO, but are we now over-diagnosing with newer modalities such as Endoflip?
Huge thanks to
@AmCollegeGastro
!
It is widely unknown how great of an impact complications have on the endoscopist and the resources available to help with coping 🫤
If you perform advanced procedures, please take a moment to fill out this survey:
Always an honor to give grand rounds, however today was more of an honor giving grand rounds to my mentors and close friends
@StElizabethsMC
!
Truly was a pleasure discussing bariatric endoscopy and the bridge between pharmacotherapy and surgery.
#GITwitter
#MedEd
@KashMahmoodMD
Exciting discussions at Getting Started with AI in Your GI Practice and Research: A Hands-On Workshop
@DDWMeeting
Will
#AI
help us truly with the resect and discard strategy to reduce waste? I believe so, but stay tuned 👀
📢Let's go to about 1-2cm under the GEJ and slowly rotate clockwise
Remember EUS 🟰 fine movements
📢You will eventually come across a big 🩸 vessel... this is the Aorta!
📢Push a little forward ➡️Celiac artery and SMA as below
📢Clockwise rotation ➡️ adrenal gland
4⃣ STEPS AXIOS Deployment (numbers outlined on AXIOS)
1. Stabilize AXIOS on EUS ▶️connect 🔥🔌▶️unlock catheter lock ▶️ advance catheter control hub (CCH) smoothly (🦶 on 🟨) until catheter is in collection then advance CCH further in (no 🔥)▶️lock
#GITwitter
#MedEd
@bostonsci
EUS in post surgical anatomy can be challenging 🙃
Pt prior history of PDAC at HOP invading ampulla s/p classic whipple now with scans revealing possible tumor recurrence in surgical bed referred for EUS
Interesting EUS images ⬇️ with pathology
#GITwitter
#MedEd
My story is only one of unfortunately so many. Please consider participating in societies like
@ECAware
@SalgiFoundation
and continue to spread awareness on this lethal disease.
I take this month to reflect on my family hx of esophageal cancer with my father and the honor I have taking care of patients/families who have to deal with this horrible disease
Please continue to spread awareness and not only can we treat this cancer, we can prevent it!