Sahaj Rathi MD, DM, MRCP
@SahajRathi
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Hepatologist, Advanced HPB Endoscopist | Faculty @HepatologyPGI 🇮🇳 |Trained 🇮🇳🇮🇹🇨🇦🇰🇷 |
Chandigarh, India
Joined September 2009
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#EUS
guided Transgastric Shunt Obliteration- a novel technique to block shunts for difficult to treat Hepatic Encephalopathy
Supplementary data out now, contains:
👉Video of the technique
👉Case details
👉EEG data
Video link:
#Endohepatology
#GITwitter
🔥Hot off the press🔥
Excited 🤩to share our novel technique - EUS guided Transgastric Shunt Occlusion (
#ETSO
) is out now
An excellent alternative to BRTO for portosystemic shunts, ETSO is
👉 Faster
👉 Less expensive
👉 No need for fluoroscopy suite
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165
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@theliverdr
Hahaha…. You kidding? This is an excellent career choice
👉Charge whatever you like. Rake in 💰💰
👉Zero liability
👉No “Primum non nocere”
👉No keeping up with evolving evidence
👉Full government support
👉Things go wrong- just dump onto a qualified EBM doctor🤘
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26
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Making academic presentations in Medicine... A thread🧵
There are many fantastic tutorials on making presentations
However, many of those are a bit too gaudy/corporate-y for academic use
Sharing what I feel are the bare essentials. Please feel free to contribute/correct
#MedX
1
66
305
🔥Hot off the press🔥
Excited 🤩to share our novel technique - EUS guided Transgastric Shunt Occlusion (
#ETSO
) is out now
An excellent alternative to BRTO for portosystemic shunts, ETSO is
👉 Faster
👉 Less expensive
👉 No need for fluoroscopy suite
16
44
165
Thrilled to share that our work was awarded the Mel Schapiro award for
@ASGEendoscopy
Best Video Presentation of
#DDW2024
among ALL categories
Incredibly thankful to Prof
@ajay_duseja
and
@drsuniltaneja
for their guidance in developing this technique
A win for
#Endohepatology
!
Interested in
#Endohepatology
?
Swing by the
@ASGEendoscopy
Video plenary session for a novel technique to manage refractory hepatic encephalopathy
Ballroom C, Monday 2pm
#DDW2024
0
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Middle aged female with episodic pain abdomen
MR showed something in distal CBD
EUS - "Railway track sign", but too small for ascaris.
Possibly a fluke...
Well, there it was... a live, fluttering
#Fasciola
hepatica!
#livertwitter
#GITwitter
7
23
142
As I boarded the early morning flight from Delhi to Ranchi this morning, I thought to myself
"I am going to the city of MS Dhoni, if only I got to see him"
Well, the universe works in funny ways.... I got my
#fanboy
moment early on
Captain cool was, indeed, incredibly cool 😎
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@MaartenvSmeden
If it doesn't come flying back, I am sure you can say it has been accepted by Nature
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Delighted to be presenting
@ASGEendoscopy
video plenary at
@DDWMeeting
for the third year in a row
After EUS guided Transgastric Shunt Obliteration(DDW 22, AJG 23), we describe another novel procedure in
#Endohepatology
- EUS guided Porto-Splenic Split!
#LiverTwitter
#GITwitter
15
5
115
Delighted to share that all 3 of our submissions to
#DDW2023
were accepted
Excited 🤩 to make it to the video plenary -
@ASGEendoscopy
World Cup this year 😀
Can’t wait to be there!
#GITwitter
#LiverTwitter
#EUS
#ERCP
#endoscopy
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5
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Delightful emails this morning 😀
Both abstracts submitted to
#ACG2023
accepted. 1️⃣ oral, 1️⃣ poster
Can’t wait to visit beautiful
#Vancouver
again, meet old friends and mentors
@mikeblez
@RobTrasolini
@peanutbutterpai
@TranaHussaini
@PeterKimMDVGH
@DrAlisonHarris
@SilviaChangMD
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3
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Complex biliary injury post CCx. Severe Cholangitis- PTBD to rescue➡️Stabilized
Antegrade & Retrograde wire 🚫🙅♂️
Cholangioperitoneoscopy rescue✅! Alternate biliary axis created
Ultimately will probably need surg, but now an elective one, and pt free of PTBD
#ERCP
#GITwitter
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13
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Thank you
#GITwitter
for all the excellent inputs🙏🙏
Post-op peripheral bile leaks persisting after ERCP can be complex
Can try FCSEMS, but usually doesn’t work
Surgical re-exploration works, but may be morbid
We report a simple technique here…
Post-op high grade bile leak (Post Hydatid deroofing)
Surgical drain in situ, 300ml bilious fluid daily
Liberal ES done, 10F stent placed. Drain still pouring out 250-300ml
Nasobiliary drain added. Leak persisting...
WDYD
#GITwitter
?
(Poll in next tweet)
#ERCP
#Endoscopy
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It’s a wrap
#DDW2024
!
Yes, it is a fantastic academic meeting
But the best part has got to be the amazing people!!
🙌Meeting idols, heroes, and mentors…
🎉Bumping into old friends…some long lost!
👩🔬🧬🔬Forging new bonds rooted in science, ideas, and visions of the future
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70/F👵with MASLD cirrhosis. Recurrent acute cholecystitis- multiple 🏥. Severe pain 2/wk
CCx-deemed high risk due to CSPH+comorbidities
Transpapillary drainage-Cystic cannulated, but wire could not be negotiated into GB due to stones
EUS-drainage to the rescue!
#GITwitter
5
11
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Teaching📹:
#EUS
-gastric variceal obliteration
Large varices require lots of coils and glue, but targeting feeders make for extremely efficient procedures
Even the largest of gastric varices can be occluded with 0-2 coils, and little glue, by targeting feeders
#GITwitter
#EUS
in the Management of Varices
Video lecture presented at the
@INASL_Liver
Annual Meet, Aug 2023
👉Some interesting concepts in Gastric varices
👉Identifying the feeder
👉Technique of
#ETSO
- EUS guided shunt occlusion
#LiverTwitter
#GITwitter
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📹:EUS Liver abscess drainage using a tubular FCSEMS
Advantages:
🚫pain
🚫hanging tubes
🚫dyscosmesis
Pt back 2 work by day 3/4- a crucial issue for those living paycheck-to-paycheck
EUS gives a unique therapeutic window for caudate and left lobe pathologies
#LiverTwitter
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Sunday Emergency Call🏥
✅EUS glue for 50mm gastric varix🩸
✅Transpapillary GB stenting for cholecystitis+Cholangitis
✅A couple esophageal varices🩸
A lazy Sunday afternoon got interesting😀
Now, time to make a steaming cup of cappuccino ☕️
#GITwitter
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Chronic Calcific Pancreatitis, Multiple PD calc, largest ~12mm at neck, upstream PD dilated
Pain++ despite optimal💊
ERCP- GW/contrast couldn't go past neck calc. Placed stent in distal PD. Pain persisted
EUS-RZV to the rescue! Struggled to negotiate GW, but worked out😮💨
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11
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Teaching 📹: POCUS for hepatic hilar assessment
Transabdominal USG gives crucial information on patency of 1° (and sometimes 2°) confluence - Usually better than MR, CT, often better than EUS
I feel every therapeutic endoscopist should know how to do this on POCUS
#GITwitter
5
13
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Many drugs being marketed for
#COVID19
in India have little to no scientific basis. Yet, these greatly inflate the cost of therapy.
In this article by
@gayathriv
,
@AnantBhan
,
@spkalantri
and I voice our concerns against unproven drugs yet again
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Excited to share that our novel work
@HepatologyPGI
on
#EUS
guided shunt occlusion has been accepted for
@ASGEendoscopy
Video Plenary session at
@DDWMeeting
2022
Hopefully, would be able to present in person... Keeping fingers crossed 😀
#livertwitter
#GItwitter
#endohepatology
13
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A CBD tightly packed with many, many stones…
The occlusion cholangiogram at the end was so satisfying!
Surg 🙅♂️, so GB stent placed too
#GITwitter
#ERCP
@docdhir
@Taalamri
@NEndoscopy
@helpatologist
@DrSalihTokmak
@drkeithsiau
@stevenbollipo
@drKumarGI
@TarunRustaGI_MD
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Transpancreatic sphincterotomy... a technique to aid in difficult biliary cannulation
Published evidence suggest it is safe and effective
However, many experts feel cutting through pancreatic sphincter is risky and/or unnecessary
Views
#GITwitter
?
How many use this technique?
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11
51
It was another 🔥 ERCP day at
@HepatologyPGI
- 🕵️🔎Laser Lithotripsies all day!
✅Hours of shooting laser beams
✅Vaporizing stones
✅Navigating large intrahepatic ducts
Pretty close to flying a 🛸, blasting asteroids, navigating spooky space-caverns 🤓
#GITwitter
#ERCP
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There once was a bile duct, beautifully stacked
With tiny little stones, all cozy and packed
In came a balloon, puffed up, tugged down
Plop! Plop! Plop! Shimmering stones all around...
#GITwitter
#endoscopy
#ERCP
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"EUS management of Gastric varices" at Stoke International Endoscopy Symposium
Could not be there in person, but delivered the lecture remotely
Excellent discussion with
@Srisha_Hebbar
@NEndoscopy
@prmphotog
#GITwitter
#LiverTwitter
#EUS
Excited to be speaking at the Stokes International Symposium on EUS management of Gastric Varices
Looking forward to a fantastic meeting 🤩
#Endohepatology
#EUS
#ERCP
#GITwitter
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Teaching 📹: Transpapillary GB drainage
We prefer to have MRCP beforehand for cystic duct anatomy
Saves⏲️and💰especially if cystic joining low, or inserting medially
Occasionally, we proceed without MRCP, as in this video
Cholangioscopy needed in <10%
#ERCP
#GITwitter
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Thank you very much
#GITwitter
community! Amazing insights. Truly grateful 🙏🙏
At the time, with available equipment and resources, this is what we did
👉2 channel scope, a snare in each channel
👉Proximal ~4-5cm constricted
👉Gently pulled to position
👉Clip to lasso
👉TIPSS
56/M, EtOH cirrhosis with hematemesis - LES tear over a varix. Needed Ella-Danis FCSEMS
36hr later, 🩸restarted. Xray-Stent migrated distally
TIPS planned, but due to certain barriers, needs another 24h
Plan - reposition stent
Any experience with how?
#GITwitter
#LiverTwitter
12
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Our fellow
@DavraBK
, just before he punctures into his first EUS-GVO (2 cases back to back actually)
Must say he did much better than my first cases. Calm and controlled
Looking forward to great things from him 😀
#EUS
#Endohepatology
#ERCP
#GITwitter
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Delighted to be speaking on EUS Guided Variceal Treatment at
#ENDOCON2022
, 8 – 10 September, Hyderabad.
Many thanks to
@DrLakhtakia
for the invitation
Do join in...
Registration link
#SGEI
#AIGLive
#livertwitter
#GItwitter
#endohepatology
4
5
51
It was a pleasure to participate in the India EUS Summit 2023 at Hyderabad
Kudos to
@AIGHospitals
@DrLakhtakia
for the fantastic organisation, amazing content, and unparalleled hospitality 🙏🙏
Grateful for the opportunity to talk on EUS anatomy, and perform a live case😀
3
3
51
Our resident
@ARPITSHASTRI_7
presenting clinical outcomes of EUS guided Transgastric Shunt Occlusion
#ETSO
for recurrent/refractory HE at
@ISHENliver
Delighted that our work at
@HepatologyPGI
was shortlisted for this select meeting of foremost Hep Enceph experts
#LiverTwitter
3
12
50
Gastric varices can be scary, but EUS is an excellent tool to tame the mighty beast!
Shared our experience at
@HepatologyPGI
at
#ENDOCON
on
#EUS
guided variceal therapy
Thank you
@AIGHospitals
@DrLakhtakia
for this opportunity
#livertwitter
#GITwitter
1
9
48
Retrieving proximally migrated stent from a non-dilated pancreatic duct 📹
Balloon 🎈- not very effective
Spy🕵️♂️- not enough space
Basket, forceps- sometimes difficult/risky to negotiate
Over the wire snare to the rescue!
Esp helpful if the wire goes through stent
#GITwitter
4
3
49
Long-term GB drainage in poor surgical candidates
We have been doing more of these lately at
@HepatologyPGI
Usually we go with 1 stent, but some data suggests 2 stents maybe better… 🤔
Thoughts 💭?
@DouglasAdlerMD
@ChahalPrabhleen
@ReemSharaiha
@helpatologist
@NEndoscopy
5
3
48
Bilateral SEMS across a tight Bismuth Type II Hilar Stricture. This was after dilation by a 6mm balloon on both sides!
I used different types of stents for each duct due to their delivery system characteristics.
What is your preference for bilateral SEMS
#GITwitter
? Poll👇(1/2)
5
6
47
EUS-pressures… A fascinating opportunity to assess presinusoidal PHTN
HVPG 👎 here
EUS ✅
👉25G FNA💉
👉PV, f/b HV/IVC
Voila! We have true Porto-Systemic gradient
🚫need for special pressure measuring 💉
Any 💉 works with std multipara monitors
#Endohepatology
#GITwitter
7
10
44
It’s a wrap at
#ENDOCON2024
3 days of fascinating discussions on all things endoscopy
✅Amazing live cases
✅High quality academics
✅Unparalleled hospitality
Kudos to
@SGEIofficial
@DrRajeshPuri1
@doc_zubin
and the entire OC for the fantastic effort 👏🏻👏🏻
#GITwitter
3
3
43
Teaching 📹: Transpapillary GB stenting
📍Occasionally, cystic duct may not be accessible on fluoro. Keep cholangioscope as backup
📍2 stents may be better. Drainage mainly wick effect, so 7F/5F both work fine
📍Can use the 6G pusher to negotiate second wire
#GITwitter
#ERCP
5
7
45
Teaching 📹:
#POCUS
Malignant hilar block, referred for cholangitis. Available CT-hilar involvement unclear
POCUS - patent 1° confluence- proceed with ERCP✅
I feel every therapeutic endo unit should have a good USG machine, and also train fellows in this
Thoughts
#GITwitter
?
Teaching 📹: POCUS for hepatic hilar assessment
Transabdominal USG gives crucial information on patency of 1° (and sometimes 2°) confluence - Usually better than MR, CT, often better than EUS
I feel every therapeutic endoscopist should know how to do this on POCUS
#GITwitter
5
13
59
6
5
43
Teaching📹:Tucking Away the Tail
PD stent placed, but couldn't place the tail beyond the next fold
Now it's in the way😤
How do you tuck it away?
Forceps-fine control difficult with SVE, risk displacing stent
Tome/NK-open anyway, low risk of displacing
More tips
#GITwitter
?
6
7
41
The Magic 🪄of EUS
Cirrhosis/HCC with🩸Large gastric varices 🍇
🚰 Fed by Left Gastric Vein
⤵️ Draining into Left Renal Vein
ETSO✅
Complete obliteration of varix and splenorenal shunt in one session with a well placed shot of glue
🚫coils used
#GITwitter
#Endohepatology
🔥Hot off the press🔥
Excited 🤩to share our novel technique - EUS guided Transgastric Shunt Occlusion (
#ETSO
) is out now
An excellent alternative to BRTO for portosystemic shunts, ETSO is
👉 Faster
👉 Less expensive
👉 No need for fluoroscopy suite
16
44
165
10
5
41
Exploring Washington DC with
@drdeepakmadhu
Smithsonian Natural History ✅
Planet Word Museum ✅
Air and Space: 📸 with BlackBird✅
Capitol ✅
Now, all set for the academic festivities at
#DDW2024
@DDWMeeting
0
0
41
Young female
✅PAIN++
✅Jaundice
✅Fever
MRI
👉GB neck cal w/mural thickening
👉Prox CBD block
ERCP s/o Mirizzi (II)
➡️CBD stent - white bile
➡️GB stent - lots of pus
Instant relief in pain😮💨
Stenting CBD alone may not have helped
#GITwitter
#ERCP
#endoscopy
#gallstones
6
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Teaching 📹
EUS Evaluation of Splenoportal Axis in Portal Hypertension
#LiverTwitter
#GITwitter
#Endohepatology
1
6
40
It was exciting to present our work from
@HepatologyPGI
at the
@DDWMeeting
Video plenary on occlusion of large portosystemic shunts with
#EUS
.
Thanks to
@ASGEendoscopy
for this wonderful opportunity
#LiverTwitter
#gitwitter
@INASL_Liver
@AASLDtweets
6
2
38
This is the EUS appearance of Gangrenous Cholecystitis - A morbid complication of cholelithiasis
Persistent cystic obstruction➡️GB wall tension➡️Vascular insufficiency➡️Epithelial damage-edema, sloughing
Carries mortality of upto 20%
#GITwitter
60/F, presented with 3wk h/o
👉Pain RUQ
👉Fever
👉Jaundice
PMH- T2DM
USG/CT/MR- IHBRD, overdistended GB, cal in CD, ?CBD
This is the view from D1
Thoughts
#GITwitter
?
(CBD was clean btw)
4
1
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At the amazing
@DDWMeeting
2022
Attending a physical conference after ages is so refreshing
Intellectualy challenging sessions, sharing of ideas, and meeting old friends!
Makes the long haul ✈️✈️ and the jetlag absolutely worthwhile 😀😀
#gitwitter
3
2
38
It was a wonder experience to present our work at
@ASGEendoscopy
🌎 🏆
Fascinating session… all awesome presentations by experts around the world
Couldn’t make it to the top 3, but no regrets there…. It was an honour to present 🙏
Can an "ERCP" be done without fluoroscopy?
Is the elusive EURCP real?
Swing by on Day 4 of
#DDW2023
at the video plenary session of
@ASGEendoscopy
World Cup 🌎🏆🔦🇮🇳
Hope to see you there
#GITwitter
7
3
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6
0
40
Last weekend at the 15th International Conference and Live Workshop on
#ERCP
and
#EUS
👉Performed a live demonstration of EUS - gastric variceal obliteration
👉Lecture : EUS in liver diseases
Link to live case:
#LiverTwitter
#GITwitter
#Endohepatology
5
4
40
#GITwitter
#Endoscopy
You need to achieve hemostasis in a mucosal bleed
Argon Plasma Coagulation not an option
👉 Argon cylinder is empty
👉 Out of APC electrodes
👉 Electrocautery unit does not have APC module
What do you do?
This is how we improvised
5
9
40
1
1
39
Laser lithotripsy of GB stones through previously placed GB LAMS
No expensive, single use cholangioscope needed
An ultrathin endoscope with a single lumen cannula can carry laser fiber, works fairly well
#GreenEndoscopy
Looks and feels very different though
#GITwitter
#ERCP
6
4
39
Excited to be speaking at the Stokes International Symposium on EUS management of Gastric Varices
Looking forward to a fantastic meeting 🤩
#Endohepatology
#EUS
#ERCP
#GITwitter
Sharing the details of the Stoke EURCP symposium. A great opportunity to discuss, share knowledge and learn from each other. Look forward for the interaction.
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Post-op high grade bile leak (Post Hydatid deroofing)
Surgical drain in situ, 300ml bilious fluid daily
Liberal ES done, 10F stent placed. Drain still pouring out 250-300ml
Nasobiliary drain added. Leak persisting...
WDYD
#GITwitter
?
(Poll in next tweet)
#ERCP
#Endoscopy
14
9
37
Breaking stones in CBD
Laser is good- Pew Pew! 💥💥
EHL is good too- Thonk Thonk! 🔨🔨
But the most satisfying of them all… is this!
#GITwitter
#ERCP
5
3
38
We recently found out about a correspondence published against our paper in
@TheLancetInfDis
published on 17th April, 2020.
The journal failed to inform us, and now the rebuttal would take weeks to process. We shall therefore post it here. Hope that is okay (1/3)
1
35
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#Endohepatology
… we have only begun to scratch the surface of its scope!
Another addition to “One-Stop-Shop” evaluation of
#cirrhosis
in a single endoscopy appointment
#GreenEndoscopy
#LiverTwitter
#GITwitter
📹Video Digest📢
Endoscopic Ultrasound Bubble Study for detection of Extracardiac Shunting: Endohepatology in the diagnosis of Hepatopulmonary Syndrome
#LiverTwitter
#GITwitter
0
6
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5
9
37
Cystic duct cannulation for transpapillary GB drainage
Guess who used iMovie for the first time, and realised it had a Star Wars theme🤓😄
#GITwitter
7
6
37
Can an "ERCP" be done without fluoroscopy?
Is the elusive EURCP real?
Swing by on Day 4 of
#DDW2023
at the video plenary session of
@ASGEendoscopy
World Cup 🌎🏆🔦🇮🇳
Hope to see you there
#GITwitter
7
3
37
@Srisha_Hebbar
@DrAshokGastro
@drkeithsiau
@DrBloodandGuts
@KM_Pawlak
@DharJahnvi
@DrLakhtakia
@GWebster_endo
@helpatologist
@NEndoscopy
@EndoCollabcom
@KMonkemuller
@RodriguezParra_
@Taalamri
@DrHasan_Orlando
@Abraham60373150
@TarunRustaGI_MD
@SyedGerdezi
Very interesting!
Sharing a case I did similarly in a 32wk 🤰with biliary obstruction of unclear etiology, moderate cholangitis
EUS demonstrated choledocholithiasis
Cannulation with the same scope
Placement in CBD confirmed on EUS and bile aspiration
No Fluoro to 🤰👶
8
4
36
Intraductal biopsy in an elderly male with a short but tight hilar stricture
Differentials- pCCA vs IgG4
Brush cyto - no malig cells
Taking good chunks was the way to go!
#GITwitter
#ERCP
6
5
36
#EPL2023
... a fantastic endoscopy extravaganza
Kudos to the OC👏👏
⭐️Brilliant organization
🤩Live cases
🌟Content
Gave a lecture on EUS anatomy of the mediastinum-simplified for the endoscopist!
It was heartening to see our work on
#ETSO
cited in the lecture on
#Endohepatology
0
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Fascinating view of the splenoportal confluence from D1 in
#EUS
As flow from SMV and SV converges into the Portal vein, laminar nature of flow maintains the different character within the same vessel
SV -biphasic, ~10cm/s
SMV - monophasic, ~5cm/s, low flow artefacts
#GITwitter
5
11
37
Basics of
#Cirrhosis
- A
#Youtorial
broken down by timestamps
Each tweet corresponds to a section of the video
Section 1
👉Learning objectives
👉Problem statement - extent and severity
👉Changing epidemiology
#MedTwitter
#LiverTwitter
#GITwitter
1
7
35
Last weekend at
#ENDOCON
2023, gave a lecture on “EUS-guided vascular interventions”
Varices, shunts, pressures, pseudoaneurysms, thrombolysis…. The potential is enormous!
What a time to be an endosonographer 😀
#GITwitter
#LiverTwitter
#Endohepatology
0
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Glenmark's open labelled trial on Favipiravir used a flimsy primary end-point, and failed to achieve that too. Yet, they claim the drug is 'effective', and generate billions
COVID has become a cash-cow for pharmaceuticals, immune to both scientific and ethical standards
Medical experts have accused the Mumbai-based Glenmark Pharmaceuticals of cherrypicking the results of its phase 3 clinical trials to claim that its antiviral drug, favipiravir, is effective against COVID-19. |
@PriyankaPulla
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@ICMRDELHI
and
@MoHFW_INDIA
continue to recommend
#HCQS
to healthcare workers for
#Covid19
prophylaxis
Evidence: Zero
Expected benefit : unknown
Risks: rare, but not zero. Nausea to cardiac arrest
Risk-benefit ratio: You do the math!
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#ENDOCON2024
starts tomorrow 🤩
#Endohepatology
session: Will be speaking on EUS for gastric variceal bleeding
❓Can EUS GV obliteration measure up to BRTO, maybe even preferred?
❓Is the question blasphemous, or are we getting there?
Looking forward to an exciting session!
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Elderly male, frail, lower CBD obstruction
?periamp ca ? dCCA
Bil-30mg/dl, no cholangitis
ERCP attempted at outside hospital - failure to negotiate D1-D2 jn due to stricture. Transferred same day
EGD - large perforation in duodenal bulb ~18mm
WDYD
#GITwitter
?
OTSC? Surg?
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A
#legend
of Hepatology retires from
@HepatologyPGI
today
He wore many a 🎩
🎩A clinician par excellence
🎩A relentless researcher
🎩A masterful administrator, and
🎩 an endoscopist with mad skills
His work on
#ascites
and
#HRS
shaped our understanding of the topics (1/3)
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Had a fantastic time in
#HongKong
at
#IDDF2023
by
@CUHKofficial
Met
@Raymond_SY_Tang
and
@DrLoomba
- absolutely awesome people! 😀
Presented our work at the plenary session- 5 of 12 videos were from 🇮🇳 👏🏻👏🏻
Can’t wait to meet all these amazing people again in future meetings
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Our technique featured in the latest issue of
@iGIEjournal
In this video from the latest issue of iGIE, Sahaj Rathi, MD, DM, MRCP, et al demonstrate spray coagulation.
@ASGEendoscopy
@sahajrathi
@HepatologyPGI
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Chicago on the eve of
#DDW2023
Navy Pier✅
Deep-dish pizza✅
Riverwalk✅
Excited 🤩 for the sessions tomorrow! Hope to meet
#LiverTwitter
#GITwitter
peeps in person 😀
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The official Journal of
@INASL_Liver
,
@JCEH_Hepatology
now has an opening Impact Factor of 3.0
Kudos to the team for this phenomenal achievement
@a_c_anand
@RadhaKDhiman
@docMPK
@AnandVKulkarni2
@nipun29j
@RoyAHep
@kumarrahul0204
#LiverTwitter
#GITwitter
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60F, remote ERCP for CBD cal. Lost to followup
Now-biliary pain. Broken, prox migrated stent with large CBD cal
Underlying cirrhosis- 🙅♂️candidate for CCx/OLTx
Larger piece extracted from CBD. But smaller piece was lodged in CyD🤦♂️
Stent frag extracted from CyD, f/b GB stenting
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#EUS
in the Management of Varices
Video lecture presented at the
@INASL_Liver
Annual Meet, Aug 2023
👉Some interesting concepts in Gastric varices
👉Identifying the feeder
👉Technique of
#ETSO
- EUS guided shunt occlusion
#LiverTwitter
#GITwitter
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Kudos to
@spkalantri
@cspramesh
@paimadhu
@pash22
@lancelot_pinto
who led from the front, and to all who pushed back against irrational guidelines despite heavy criticism
If only this came sooner, so much money, grief, and guilt could have been prevented
More is yet to be done!
Kudos to the voices pushing for EB guidelines since last year, including
@spkalantri
and
@sahajrathi
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#HCQS
causing hypoglycemia in 1.2%
"We are not doing a trial and we don’t have sufficient evidence base to do a trial" says
@ICMRDELHI
Yet
@MoHFW_INDIA
recommends it for every
#COVID19
contact
This is the largest Ph-1 trial in history, without consent!
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Gallstones in North 🇮🇳 are crazy, but it was next level today
🪨BOULDERS🪨all day
5️⃣ ✋🏼Biliary extraction balloons *burst*💥 before lunch!
#GITwitter
, in which case(s) do you think the duct was cleared successfully? (Laser wasn’t available today)
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🔘 2
🔘 3
🔘 None
#ERCP
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An opportunity for young advanced
#HPB
endoscopy
#endohepatology
enthusiasts in 🇮🇳
@HepatologyPGI
is taking in fellows starting Jan 2023
✅Advanced ERCP
✅Diag and therap EUS
✅Large numbers of oesophageal, gastric varices
Apply by 21.12.22
DM me for details
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#ENDOCON2022
Day 3
The endoscopic extravaganza of the year comes to an end
Trained fellows on EUS-FNA techniques
Tried out the new Olympus ME-3 unit
Most importantly, basked in the wisdom of the greatest endoscopy experts
Can't wait for next year's event
#GITwitter
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#ERCP
sphincteroplasty/EPLBD
See the papilla dilate in real time - a view through the balloon
Not the clearest of videos, but around the 16s mark, the dilation of muscularis propria is beautifully seen in slow motion
📸Before vs after view at the end
#GITwitter
#Endoscopy
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