Srisha Hebbar
@Srisha_Hebbar
Followers
2K
Following
4K
Media
269
Statuses
1K
Therapeutic Endoscopist. Love to share the good and bad of my endoscopy journey. More you teach and share, more you learn.
Newcastle-under-Lyme, England
Joined November 2019
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.
2
26
55
Giant colonic angiodysplasia.- Treat only if symptomatic.- Raise it with saline adrenaline solution in Rt colon (This was in left colon).- Ablate the centre with APC first before the peripheries.@NorikoSuzuki3 @drkeithsiau @BilalMohammadMD @EndoCollabcom @KM_Pawlak
17
44
280
How easily this could have been missed! This was the first lesion "AI" helped me in picking up the lesion. Hepatic flexure lesion. Biopsies - Tubular adenoma LGD. @drkeithsiau @NorikoSuzuki3 @DrBloodandGuts @BilalMohammadMD @alerepici @thomas_rosch @DrBuHayee
13
24
194
This is a "no panic" situation. The bowel is clean, the position is right. You can't be in a better place. What's your choice of accessory ? @drkeithsiau @stevenbollipo @DrBloodandGuts @BilalMohammadMD @TarunRustaGI_MD @NorikoSuzuki3 @alerepici @thomas_rosch @gastro3570
34
33
181
A bouquet of flowers!! Primary fistulotomy and intraductal adenoma #GITwitter @GWebster_endo @NEndoscopy @helpatologist @SahajRathi @docdhir @DrLakhtakia @SultanMahmoodMD @DharJahnvi @Taalamri @drkeithsiau @SunilAminMD @ESGE_news @ASGEendoscopy @BSGTrainees
15
28
177
EUS Rendezvous. Panc ca, ulcerated D2. Unable to locate papilla. EUS RZ.wire passed across papilla. Unable to cannulate next to wire. Wire pulled back slowly to know the point of exit and followed up at the same time by sphincterotome. @docdhir @DrLakhtakia @AnandSahaiEUS
17
32
157
Management of refractory benign oesophageal stricture. Excellent presentation by @ParthaP32580643. @AIGHospitals @BSGTrainees @drkeithsiau @abdullahaabbasi
4
58
146
Looking at the appendix from a distance is not enough. As @Bjorn_Rembacken says, "kiss the appendix" @DisneyBen @BSGTrainees @drkeithsiau @GI_Pearls @DrBloodandGuts @BilalMohammadMD @stevenbollipo @TarunRustaGI_MD @SultanMahmoodMD @NorikoSuzuki3
5
15
127
Never underestimate the size of SSL! @BSGTrainees @drkeithsiau @DisneyBen @NorikoSuzuki3 @SDolwani @BilalMohammadMD @TarunRustaGI_MD @AdvaniRashmiMD @SultanMahmoodMD @ESGE_news @stevenbollipo @DrBloodandGuts @DrBuHayee
9
9
125
Endophysics - The refractive index of 💧 is 1.333. so, the under 💧 magnification is 33%. Very useful to assess residual lesion & vasculature. @drkeithsiau @DisneyBen @stevenbollipo @BilalMohammadMD @NorikoSuzuki3 @TarunRustaGI_MD @DrHarryThomas @my_ueg @videogie #GItwitter
7
29
121
Oesophageal inlet patch. Do you treat them? how and when ? @gi_jasondunn @BritSocGastro @GastronautIan @drkeithsiau @vega_roser @BilalMohammadMD @TarunRustaGI_MD @stevenbollipo @DisneyBen
11
18
107
"A team that eats together works well together". Friday lunch at endoscopy unit @UHNM_NHS #GITwitter
7
1
86
Direct cholangioscopy using nasoendoscopy (free hand technique). Technically, unusual to reach the hilum with free hand technique. Good views of cystic duct valves (valves of Heister). #GITwitter
7
13
91
"Dancing mucosa" during cannulation is a sign of false passage. STOP! and never inject contrast. I show this old video in our ERCP course. "How I do it" is important but trainees gain more when they see.➡️ Our failures and what we learnt .➡️ Reflections from our complications
6
16
73
ERCP - How reliable is fluoroscopy to identify periprocedural periampullary perforation? Which one of these is a perforation? @drkeithsiau @KM_Pawlak @DharJahnvi @AdvaniRashmiMD @helpatologist @NEndoscopy @DrBloodandGuts @DouglasAdlerMD #GITwitter @ChahalPrabhleen @KMonkemuller
46
14
72
How reliable is flouro ?.➡️1st ERCP. 2 🪨 removed from a convoluted duct. Duct confirmed clear.➡️Cholangitis in 3/12.➡️MRCP CBD 🪨. Sphincteroplasty and 15-16.5 mm 🎈trawl. Small 🪨 extracted.➡️Flouro - duct ? clear.➡️Direct cholangio with nasoendoscope. Suction. Another big🪨
8
9
69
Polyp surveillance - "Bunch of grapes" at the appendix orifice. Submucosal, so histo normal. CT Normal. Was seen during previous colon 4 yrs ago. Patient asymptomatic. I have no clue what this is @drkeithsiau @BilalMohammadMD @NorikoSuzuki3 @Noor_Endo @JTA_Endo @DrBuHayee
16
9
65
Reusable cholangioscope, Bands/clips/endoloop with reusable applicators at Indian conference #ISGCON2023 . This is what we need in the Western World to reduce waste @GreenEndoscopy @DrBuHayee @drkeithsiau @anjan_dhar6 @gastrosid #GItwitter
4
9
68
Endophysics 2 - when light travels from under 💧to air💧surface, some rays are reflected back into water. If the 📷 is placed at a critical angle (< 41 deg -Snell's law), all the rays are reflected back and the interface acts as mirror #GItwitter 1/
2
14
65
Post sphincteroplasty bleed. Significant clots within the duct and active ooze. For the therapy to be effective, the clots need to be removed. Balloon trawl didnt help. Direct cholangioscopy with nasoendoscope (5.9mm diame). Clots removed. Haemospray. Effective! #GITwitter
7
8
65
Opening the floodgates! Primary fistulotomy is the right approach in selective cases. Understanding the ampullary morphology is the key.@DrBloodandGuts @BilalMohammadMD @helpatologist @drkeithsiau @GIscope_updates @GWebster_endo @NEndoscopy @stevenbollipo #GITwitter
5
6
62
Appendix submucosal lesion - CT suggestive of NET. Hemicolectomy. Bx - lipohyperplasia with features of early appendicitis. Lipohyperplasia/lipomatosis is increased infiltration of highly differentiated fat. differs from lipoma by lack of capsule. #GITwitter
0
7
57
4 hours. 14 advanced PB endoscopy cases showcased by 2 World class centres (AIG, Hyderabad and Deenanth Mangeshkar, Pune). It was an educational treat to the British PB endoscopists @DrLakhtakia @amolbapaye @UHNMEndoscopyTC #stokeercpeus22
5
7
54
We had a full house on the last day afternoon session at #BSGLIVE23 . The candid discussion with videos on learning/reflections from complications was well received. @AdrianStanleyGI @HelenSteed1 @babudayyeh @gastro3570 @JohnMorris_Endo @BottProf @gastrosid
3
2
54
A story of positivity and life purpose!.My colleague, a respected hepatologist and ironically one of the first women in the region to perform ERCP developed metastatic pancreatic cancer. She trusted me to do her EUS & ERCP, which were challenging. 1/3.
4
10
53
Long bulged ampulla with papilla pointed downwards (papillary tumour). Primary fistulotomy is the right approach #GITwitter
2
2
56
GI bleed - Primary OTSC is effective when the area of concern is en-face (90 deg to the tip of the scope). The prepyloric ulcer bleed is the perfect location for this. #GITwitter @BSGTrainees @drkeithsiau @DisneyBen @DrBloodandGuts @ESGE_news @ASGEendoscopy @JohnMorris_Endo
2
10
55
Pankaj Desai's excellent talk on "Varices rebleed".First and foremost, it is important to understand the anatomy and pathophysiology.#BSGLIVE22
1
16
53
Stoke ERCP EUS symposium. The day before the event!! After 2 Covid related cancellations, we are back here to learn and share. @UHNMEndoscopyTC @abdullahaabbasi @GWebster_endo @NEndoscopy @helpatologist @prmphotog @drkeithsiau @DrLakhtakia @amolbapaye
8
9
52
Case based discussions, model training, hands-on live cases, video cases, microteachings - Its all happening here at Day 1 and 2 of Stoke basic ERCP course. Awaiting more excitement on the final day @UHNMEndoscopyTC @abdullahaabbasi
3
5
52
Ana Wilson talk on management of Radiation proctopathy @BritSocGastro endo webinar. How many of you use sucralfate? Time to get away from APC? @anjan_dhar6 @drmanmeetm @AiredaleDodger
4
13
50
Propofol assisted endoscopy,live course for anaesthetists. 4 cases perfomed, including a case where a single patient had scope changed 7 times ( EUS FNB/failed Fistulotomy/attempted EUS rendezvous, and finally EUS CDD). 1/2
6
3
50
Day 2 @kingslivelondon. Metastatic panc ca. Ampulla distorted, floppy and position unstable .Learning points.Cannulate close to papilla. Required significant clockwise body movement. In this case,180 deg.@TheBileDoc @GWebster_endo @HajiAmyn @SahajRathi @helpatologist @Taalamri
3
5
50
Sparklers, jewels and lights in endoscopy. Happy Diwali everyone. Have a cracking celebration! #GITwitter
4
4
48
What's unique about this flouroscopy?.@drkeithsiau @DrBloodandGuts @KM_Pawlak @DharJahnvi @DrLakhtakia @GWebster_endo @helpatologist @NEndoscopy @EndoCollabcom @KMonkemuller @RodriguezParra_ @Taalamri @DrHasan_Orlando @Abraham60373150 @TarunRustaGI_MD @DrAshokGastro @SyedGerdezi
13
7
49
The first glimpse of the doyen of the ERCP world. Day 2 of Stoke ERCP EUS symposium @UHNMEndoscopyTC @DrLakhtakia @amolbapaye @drkeithsiau @helpatologist @SyedGerdezi @drnataliegastro
0
5
47
First JAG ERCP upskilling course. 2 days of hands-on ERCP. coming together of experienced ERCPists, learning from each other, sharing good practice, discussing personal complications, take home messages. @UHNMEndoscopyTC @JAG_Endoscopy @docdai
2
5
44
Subtle colonic lesion.Another example of subtle periappendicular lesion.@BSGTrainees @drkeithsiau @DisneyBen @SDolwani @KM_Pawlak @AdvaniRashmiMD @NorikoSuzuki3
4
5
47
"Clinical controversies in endoscopy"webinar series has been one of the popular webinars from @BritSocGastro endo section. We have discussed the following. What will the next topics be? Await the BSG announcement. Meanwhile, SAVE THE DATE May 16th 18-1930.
2
11
45
EUS CDD - This algorithm again worked. 19g needle ➡️wire➡️ hotaxios over the wire.Initially wire curled and took some time to get the wire in the right direction. Once 🔥 axios puncture is done, procedure has to be quick. No room for wire manipulation later
7
11
44
Reinforcing the need to clean and Kiss the appendix #reducingPCCRC #GITwitter @NorikoSuzuki3 @SDolwani @SarahTom123 @kevinjmonahan @DisneyBen @drkeithsiau @BSGTrainees
8
5
45
EUS HGS for panc ca with GOO. I use🎈 for track dilatation. Do you use cystatome or balloon ?.Do you place plastic stent through giobor stent?.@DrLakhtakia @amolbapaye @SunilAminMD @TarunRustaGI_MD @helpatologist @NEndoscopy @ChahalPrabhleen @sahajrathi
9
5
45
Innovations in endoscopy!! Thought provoking talk by Prof Cesare Hassan. Use of AI to understand the ESD planes, Robotic ESD, etc @kingslivelondon @HajiAmyn @DrBuHayee @JTA_Endo @ESGE_news
0
7
40
Live case to #endoport2023 . Panc ca, Duod stent insitu. ⬆️ Bil. Attempted HGS. Due to large hiatus hernia, positioning was difficult. Track dilatation/stenting couldnt be done. Cholecystogastrostomy done. Plan -If bili doesnt ⬇️, OGD scope thro 🔥 axios, wire,DPT stent CBD
11
4
45
GI stents - Summary of recommendations (from @ArunimaVerma11 Tata Hospital, Jamshedpur) @BSGTrainees @drkeithsiau @abdullahaabbasi @DharJahnvi @KM_Pawlak
0
19
41
Day 1 of basic hands-on ERCP course.Half a day is dedicated to case base discussions (Gastroenterologists, PB surgeon, radiologist and trainees). The most important aspect of ERCP is to know "when not to do". #GITwitter
0
3
40
Migrated metal stent removal - Case done elegantly by @drgavinoz #2022stokesymposium. Balloon trawl from above the stent. The stent moved down. Under flouroscopy, the lower end of stent was grabbed with grasping forceps & pulled. What other techniques do you use? #GITwitter
5
4
39
There is an opportunity for a well motivated individual to join us as a PB endoscopy fellow. @UHNMEndoscopyTC we are protraining and every fellow has gained significantly. DM me for more details.@BSGTrainees @helpatologist @GWebster_endo @drkeithsiau.
2
14
40
Primary CDS - Naonegenerian. Ampullary lesion with liver mets. When the duct size is 2 cms, and scope in a stable position, no messing around here. Straight to 6x 8 mm LAMS and out! #GITwitter
2
7
39
EUS GJ with hotaxios. Though the position was ideal, puncturing the jejunum was a challenge. Changed the diathermy cable, but still struggled for some time. Anyone encountered similar challenges with hotaxios EUS GJ #GITwitter
7
7
38
We have worked towards getting our GI trainees off the GIM rota for 3/12 in a year. During this time, they do Gastro/GI bleed oncall with the consultants. An ST5 oncall with me this weekend, learnt about endo timing/scoping in theatre vs endo unit/mode of Rx, etc. @BSGTrainees
6
3
38
A small effort from our end to improve access to propofol in endoscopy. Kindly encourage your anaesthetists to attend this one day course. Our last 2 courses led to 3-4 centres developing the service in their trusts.@NEndoscopy @GastronautIan @SimonMEverett @GWebster_endo
2
15
38
Stoke basic hands-on ERCP course. @sheiybani cannulated twice in the course (never done before!). Most importantly, what the delegates learnt was that, case selection is the most important part of ERCP. We cancelled 2 ERCPs by doing EUS (for low probable stones) #GITwitter
1
3
36
Behind the scenes of BSG live endoscopy. Looking forward to all the exciting cases lined up by simoneverett and Leeds team. @BritSocGastro @Noor_Endo @NorikoSuzuki3 @GastronautIan @Bjorn_Rembacken .#BSGLIVE22
0
2
37
Good and bad of EUS CDD -. In smaller CBD (8-10mm here), I feel safer by puncturing with 19g 💉 and passing the wire in the right direction and then passing the hotaxios (6x8) over the wire, rather than free hand technique. This is due to one of my earlier experience 1/2
1
10
36
Endophysics! When light is shone at an angle from less dense to more dense (air to water), light is refracted towards the normal. The normal is the line perpendicular to the boundary between 2 substances.#GItwitter @BSGTrainees @drkeithsiau @DisneyBen @BilalMohammadMD
2
8
35
🐘 trunk ampulla!.➡️Never rush to cannulate as soon as u see the papilla. Sometimes, the "right path" is not the easiest one.➡️ Tip down pull back and assess the morphology.#GItwitter #Endotwearls @drkeithsiau @KM_Pawlak @AdvaniRashmiMD @BSGTrainees @abdullahaabbasi
3
3
35
3
0
34
Day 3 - Basic hands-on ERCP course. A trainee doing his first fistulotomy in the course.Practice movements followed by the cut.Fistulotomy is an important technique to learn for every ERCPist. Primary fistulotomy in a bulged ampulla. @UHNMEndoscopyTC @NEndoscopy #GITwitter
2
3
33
Shall we guess this patient's journey? What is the present challenge?@drkeithsiau @SyedGerdezi @GIscope_updates @shanilkadir @helpatologist @TarunRustaGI_MD @DrBloodandGuts @tberzin @helpatologist @alerepici @GWebster_endo @thomas_rosch @drcshekhar @KM_Pawlak @AdvaniRashmiMD
7
2
33
DGW technique.To be successful, use the wire in PD as a guide to know where your line of cannulation should be. Tip down and form a slight loop in the PD wire and then cross the sphincterotome over the PD wire and cannulate in the direction of BD (11 o`clock position) #GITwitter
🔴Teaching point; .I am not a big fan of the Double guide wire( DGW) technique; with low thresholds to escalate to transpancreatic sphincterotomy. Despite theoretically there is a risk of Pancreatitis from my limited observation such a technique is associated with a successful
5
8
32
@TarunRustaGI_MD @kikarrion @KMonkemuller @stevenbollipo @gi_jasondunn @BritSocGastro @GastronautIan @drkeithsiau @vega_roser @BilalMohammadMD @DisneyBen @DrBloodandGuts @DrBuHayee .What I do.➡️ slow withdrawal+/-NBI.➡️Treat symptomatic (Globus) with APC. No need to Bx.➡️ Sedation (mid+fent).➡️ Lift the lesion and pulsed APC.➡️Lifting prevents microperforation.➡️Good symptomatic response at 1 yr
8
4
33
Time for @bostonsci to tweak the design. Ability to resheath the LAMS is a very important safety feature. @DouglasAdlerMD @DrLakhtakia.@docdhir @NEndoscopy @helpatologist.@DrHasan_Orlando @manuknayar.@sahajrathi @tberzin .@ChahalPrabhleen @TarunRustaGI_MD.
8
9
31
Endophysics: Removal of foreign body from the stomach is all about understanding the vector equation of the line.#GITwitter #MedTwitter
3
3
28
GAVE - what's your treatment options? I use combination of bands and APC between the bands. Looking forward to what Matthew Banks has to say @BritSocGastro clinical controversies in endo webinar at 6pm "GAVE-APC, banding or RFA?@GastronautIan @DisneyBen @anjan_dhar6 @drkeithsiau
2
3
30
Stone disease. Proximal high migration of 10fr plastic stent. Unable to pull it down with 🎈. Standard basket and spy accessories didn't help. Looked like the stent was fixed. What are your options? @Taalamri @docdhir @sahajrathi @NEndoscopy @helpatologist @GWebster_endo
18
4
31
Failed fistulotomy. EUS Rendezvous. Wire came out through D1!! Has this happened to you?.Changed to HGS. Dilated tract through 4 mm balloon, giobor stent @docdhir @DrLakhtakia @AnandSahaiEUS @MendozaLadd @helpatologist @NEndoscopy @sahajrathi @TarunRustaGI_MD @Jayanta_sam
7
7
30
3/3 Alison has pledged money for liver charity, motivated >700 people to join her on 5K parkrun, and now inspiring millions! Please donate (even a penny) and make a difference to her life.@UHNMCharity #GITwitter @BritSocGastro @BBC
0
3
27
Stoke EURCP meeting - Will appeal to trainees, nurses, general to advanced endoscopists. Good quality discussion & collaboration with high quality national/international colleagues is the biggest appeal. Look forward to seeing many of you! Details soon!!.#GITwitter
3
4
29
Peek-a-boo! As if the challenges in cannulation are not enough!Case 1 @GIscope_updates @AdvaniRashmiMD @stevenbollipo @helpatologist @TarunRustaGI_MD @drkeithsiau #GITwitter
6
2
30
Primary CDS - Elderly, difficult to sedate, long lower CBD stricture. 15-17 mm CHD on EUS. When time is of the essence, and anatomy is favourable, primary CDS is a good option #GItwitter @docdhir
2
4
29
Instafan (one pass needle) - New EUS needle. Slide taken from Vivek Kaul's presentation #ISGCON2023 . #GItwitter
3
5
28
@DisneyBen @JAG_Endoscopy I have kept a detailed personal prospective data of every procedure I have done for the last 10 years, including histo, complications,trainee involvement etc. This has not only helped self reflection, but has now given me a good data to analyse and hopefully publish
9
1
27
Celebrating International nurses day with the diverse, hardworking, fun loving @UHNMEndoscopy team. It was a grand feast! @CarrionAngel @vickikpoole @mjvlewis
4
3
24
What an amazing talk by @docdhir on EUS guided panc duct drainage. @Nareshbhat14 @Kayalvn #ISGCON2023
1
3
28
It's Doyen of ERCP (Peter Cotton's) birthday. Remembering the time we celebrated his 80th at Stoke (4 yrs ago), with educational meetings and a couple of parties which included the best food in the world 😉 #idli @UHNMEndoscopyTC .#GITwitter
2
1
26
I am coming off BCS list after 10 yrs for 2 reasons.➡️ As I can't train trainees on BCS lists.➡️To focus on PB endoscopy. At this stage of my career, I feel my contribution is limited, if I can't have a trainee on every list. 1/2.
6
0
26
#GITwitter did you know that the first fibrroptic gastroscope was a side viewing one. Peter Cotton continues to educate and inspire us.
0
6
25
This is going to be a very interesting and engaging webinar.@BritSocGastro @GastronautIan @drkeithsiau @richlaing @Marktheliverdoc @WolfsonEndo @UKGastroDr @awmckinlay @drmanmeetm
0
12
27
Fireworks around bile duct! Choledochal varices in a patient with NASH cirrhosis and PV thrombosis
3
0
27
It is not enough to "kiss the appendix". We need to tip down and examine the "blind spot" between the appendix and IC valve. @drkeithsiau @NorikoSuzuki3 @SDolwani @BSGTrainees @BilalMohammadMD @stevenbollipo @TarunRustaGI_MD @SultanMahmoodMD @Bjorn_Rembacken @DisneyBen
5
1
26
@dr_aditi_kumar We have to change how we train. The concept of training trainees only in "training lists" has to go. The trainees should have opportunity to go to any list (ad-hoc). The trainers need to be trained how to train in a busy list. "Targeted training" can be delivered in any list.
5
2
26
Another interesting @BritSocGastro webinar coming up. Looking forward to the discussions. @DisneyBen @anjan_dhar6 @drkeithsiau @UKGastroDr @GastronautIan @NEndoscopy @drnataliegastro @matthewbanks @AiredaleDodger @BSGTrainees
2
11
26
Pretty colours, huh? Not some thing an endoscopist would ever want to see. Important to know what this is and recognise it early. Early endo management of complications saves lives @drkeithsiau @DrBloodandGuts @TarunRustaGI_MD @stevenbollipo @BilalMohammadMD #GITwitter
4
3
26
@drkeithsiau Seen in diminutive adenoma. ppears red in white light, brown in NBI. can be confused for "depressed"lesion which is indicative of neoplastic lesion. "valley" will have sloping edge and depth is quite superficial. True depression will have sharp edges.
1
0
25