Tyler Berzin MD, FASGE
@tberzin
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Assoc. Professor @HarvardMed | Advanced Endo @BIDMCHealth | @BrighamMedRes & @BrownMedicine Alum | Favorite initialisms: ERCP/EUS/AI. Link below for COI
Boston, MA
Joined July 2011
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Pinned Tweet
How many advanced endoscopists can correctly identify the liver segments drained on a cholangiogram? Here's some 'advanced' ERCP anatomy (featuring
@ericpaulimd
's famous fist).
#GItwitter
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361
@DrHarryThomas
@ebtapper
We actually just received our first shipment of Tesla colonoscopes...
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558
As I always say, “Colonoscopy can help us find polyps, can help us prevent colon cancer, and in very particular cases, may help us elevate a woman to U.S. presidential power for the first time in history”…
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456
1/4: Why is a thin nasal feeding tube often called a ‘Dobhoff’? The original thin-caliber, weighted feeding tube was invented in 1975 by Dr. Robert Dobbie and Dr. James Hoffmeister. They joined their names for ‘Dobhoff’ (and also used the spelling ‘Dobbhoff’ interchangeably).
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For every 10 likes this gets I will ask chatGPT to make this endoscopy unit even more advanced. ⚕️🤖🪐
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Mastering linear EUS is a tough hill to climb, even for our superb advanced endoscopy fellows who have already mastered basic endoscopic skills. Here's lesson one.
@BIDMChealth
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Got a question re: more basic cholangiogram anatomy, so here's lesson 1.
#ERCP
#GItwitter
#DistanceMedEd
How many advanced endoscopists can correctly identify the liver segments drained on a cholangiogram? Here's some 'advanced' ERCP anatomy (featuring
@ericpaulimd
's famous fist).
#GItwitter
9
122
361
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180
"How I cannulate the bile duct". At least once a year, I revisit this classic, brief reflection on
#ERCP
technique, by Hawes & Devière. (Published in both
@GIE_Journal
and
@endoscopyjrnl
in 2018).
2
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Great to return 'home' to
@BrighamMedRes
to talk about GI bleeding.
Here are my 4 top points on:
▶️IV flow rates
▶️Ulcer stigmata + rebleeding risk
▶️Setting patient expectations for LGIB eval
▶️Recommended LGIB algorithm
10
35
168
Getting to co-author an
#AI
essay in
@TheLancet
with the legendary
@EricTopol
, physician-sage and author of
@Deep__Medicine
, was, for me, the academic/medical equivalent of getting to toss a football around with
@TomBrady
. Thanks Eric 🙏🙏 🏈 🏈
Our new
@ThaLancet
Digital Medicine essay is especially timely
It's on
#AI
-assisted endoscopy w/
@tberzin
, a co-author and collaborator in 3 randomized clinical trials
@BIDMChealth
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10
22
166
We are so excited to welcome
@ImanBostonMD
and
@CPattniMD
to the
@BIDMC_GI
Advanced Endoscopy team via
@ASGEendoscopy
match, along with our international fellow
@pelegnoam
, for the 2023-24 academic year. Congrats to all. The future of advanced endoscopy look bright!
24
9
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Whoever did
#RBG
’s
#ERCP
stent exchange today
@HopkinsMedicine
, I hope that you did your *VERY BEST* work. That is all.
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155
if the way this guy is holding the scope is any indication, there is a hospital somewhere out there in serious need of gastroenterology help
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Nice demonstration of ‘push technique’ for deploying Axios inner flange in *small spaces*:
➡️ unlock BOTH catheter lock & stent deployment hub
➡️ stabilize stent deployment hub against chest with two fingers
➡️ push Axios forward, keeping stent deployment hub *fixed in position*
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1/ It's recruitment season again for the
@ASGEendoscopy
Advanced Endoscopy Match. Here's a brief tweetorial about what you can expect from training at the Center for Advanced Endoscopy
@BIDMC_GI
,
@BIDMChealth
, and
@harvardmed
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145
“Twitter can be a haven for physicians who hope to rekindle and stimulate the curiosity that made them choose a career in medicine.” -
@tony_breu
. Amen.
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If you trained in advanced endo within last 10 yrs, you might not have seen this technique:
➡️Needle-knife endoscopic pseudocyst drainage without EUS guidance
➡️Mostly/entirely replaced by EUS, but an important early endoscopic innovation
➡️Courage is used instead of doppler
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1/ It's recruitment season again for the
@ASGEendoscopy
Advanced Endoscopy Match. Here's our 2022 tweetorial about what you can expect from training at the Center for Advanced Endoscopy
@BIDMC_GI
.
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Bilal you broke the curve. Again.
@LancetGastroHep
@DDWMeeting
@IrisWangMD
@MicroMindy
@NatRevGastroHep
The most ‘impactful’ tweeters were
@BilalMohammadMD
,
@DDWMeeting
,
@ebtapper
,
@NeenaSAbrahamMD
, and
@IBDMD
. (3/7)
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1/9 Quick synopsis of our recent double-blind randomized study on computer-aided polyp detection in
@LancetGastroHep
, which can be found here:
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Getting read to talk about GI bleeding this morning at
@HarvardHospMed
course. Here are 4 key concepts:
1) Ulcer stigmata & re-bleeding risk
2) EGD timing for upper GI bleed
3) when to consider angio for UGIB
4) simple algorithm for lower GIB
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130
A helpful but *very subtle* teaching point for those performing enteroscopy or ERCP in Roux-en-Y anatomy
In hepaticojej ➡️ cross JJ suture line, biliary limb is continuous w/common (enteral) limb
In gastric bypass ➡️ cross JJ suture line, biliary limb is continuous w/blind end
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We could not be prouder of our graduating advanced endoscopy fellows
@BIDMC_GI
@harvardmed
- all already on their way to become leaders in the field.
@SultanMahmoodMD
(
@PittGILiverNutr
),
@SamIgbinedion
(
@UTChattanooga
),
@EHolzwanger
(
@TuftsMedicalCtr
).
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Had a talk with a med student today struggling between two specialty choices for residency.
It's common that specialists who like their fields (like I do) act as cheerleaders re: why their particular field is so cool (and others are not).
Here's my alternative advice:
#MedEd
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The more things change the more they stay the same.
First Friday for new
@BIDMC_GI
advanced endoscopy fellows…it’s 10PM and we’re preparing for our last case. Great work
@SamIgbinedion
,
@EHolzwanger
,
@SultanMahmoodMD
!
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We are so happy to announce our 2024 advanced endoscopy fellows at
@BIDMChealth
&
@harvardmed
. Congrats to all of our future adv endo colleagues in the
@ASGEendoscopy
match!
Dr. Lillian Wang (
@MayoClinicGIHep
)
Dr. Faisal Ali (
@UTHealthGastro
)
Dr. Amanda Lim (
@RoyalAdelHosp
)
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“The hospital pen thief, an apology to my nursing colleagues” (haiku and still life portrait, T. Berzin 2021)
“Could I use your pen?
I will return it to you..”
Once more, I forgot.
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Not just “in the categorical spots”, but “in ALL the categorical spots”.
@TsengJennifer
for the win. Congrats to all
@BMCSurgery
.
#SheLooksLikeaSurgeon
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Physicians and nurses performing GI/biliary procedures should wear non-porous shoes. Thank you for coming to my TED talk.
16
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Just a typical day in endoscopy where your
#AI
freezes bc of an
#ubuntu
prob, but then your adv. endo fellow (
@vaibhav_manu
) walks by & says don't worry, I code in ubuntu.
Sort of like getting cholangitic at
#Google
HQ & your lead programmer says, don't worry, I do
#ERCP
.
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Advanced endoscopists, look familiar?
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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.
19
8
109
Proud day for
@BIDMC_GI
with
@AmerGastroAssn
featuring front page work by
@ebtapper
and
@jglissenbrown
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Today, Friday the 13th, is the first time I’ve seen a pancreatic FNB specimen try to rise out of the path jar 😱
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@BilalMohammadMD
:
@GIE_Journal
and
@AmJGastro
tweeting about your 1st author works within 13 minutes of each other. You are too productive and if you weren’t such a nice person and generous mentor it would be simply insufferable. 🎉👏
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When your former advanced endoscopy fellow and now superstar
@BIDMC_GI
@harvardmed
endoluminal surgery colleague smirks at your path specimen jar….
#ESD
#thirdspace
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103
Very cool EUS-guided PEG for if transillumination fails:
➡️ Fill surgical glove w/water & place on abdomen as EUS ‘target’
➡️ EUS FNA from stomach to glove w/ 19g needle
➡️ Pass wire thru needle & out stomach
➡️ Use wire to pull peg string into stomach -> standard pull technique
@Rishishah_17
@KapuriaMd
@AsadurRahman87
@ScopingSundays
@Samir_Grover
@RobertoSimonsMD
@AhmadBazarbashi
@vaibhav_manu
@rmulkimd
@BilalMohammadMD
@NnekaUfereMD
@LizzieAbyMD
@DrMalSimons
@DrMohdZein
@AdamKichlerDO
@ChahalPrabhleen
@tberzin
Endoscopic ultrasound-guided percutaneous endoscopic gastrostomy.
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Remembering
@BIDMChealth
nephrologist &
@UpToDate
founder Dr Bud Rose: “Bud’s idea, and its execution, represent..the most important medical invention in the past 30 years... I’ve argued more than once that he should have won the Nobel Prize for medicine.”
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**Congrats to all who matched in
@ASGEendoscopy
match during this very competitive year**
My unofficial count:
63 matched spots, 11 women (17.5%).
Still many miles to go.
2019 results for comparison below.
@allie_schulman
@ChahalPrabhleen
@FergaGleeson
@WomeninEndo
Congratulations to all who matched in advanced endoscopy this year. Some important data for
@ASGEendoscopy
in 2019: I count 70 matched fellowship applicants, 9 women (12.8%). I can't find any specialty match with lower %. Can anyone name one? We must do better.
@WomeninEndo
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1. Where is the 'distal' CBD?
2. Where is the 'distal' PD? (and is it removed during a distal pancreatectomy?)
Lots of GIs/Surgeons disagree on
#1
and
#2
.
▶️Be more *specific* whenever possible ('lower CBD', or 'PD in head of panc') h/t
@HarshitKharaMD
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29
93
Today I learned from the great Marty Freeman (
@UMN_GI
) that he uses tapered tip catheter for epi injection during ERCP for post-sphincterotomy bleeding:
1) Easier to get over elevator vs needle
2) Less likely to cause mucosal tear/scrape
3) Allows for effective SM injection
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As a general rule, the best decisions you can make in advanced endoscopy usually land on the side of simplicity and discretion rather than novelty and daring.
5
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Not my EHR dictation software catching me ask my kid to take our elderly dog on a walk and accidentally creating a pretty compelling
#colorectalcancer
screening campaign.
#GetScreenedOrMyDogWillPeeOnYourRug
@CCAlliance
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Did the first robot-assisted ERCP involve a completely novel endoscopic platform? Nope, it actually appears to be an endoscopist controlling a robot controlling a ...traditional ERCP scope. Baby steps...
h/t
@ahmad_madkour
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What does your advanced endoscopy team need to know when you are requesting consult for possible ERCP?
@BilalMohammadMD
covers it during his lecture to
@BIDMC_GI
:
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94
New over-the-scope endoscopic grasper. I can think of 1000 uses.
#Foodbolus
#necrosectomy
....
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96
The “poppy seed test” (feed poppy seeds, then look for them in urine) has favorable test characteristics for identifying colovesical fistula compared to CT, MRI, and other expensive choices. What’s your favorite low-tech diagnostic tool?
#lowtech
#medtwitter
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Great
#ERCP
reference from
@ChahalPrabhleen
:
➡️ microdissection of 19 cadaveric duodenal specimens
➡️ key finding: a 'window' of ⬇️ vascularity at 10-11 o'clock from biliary orifice
➡️ hypothesis generation: aim towards 10 o'clock for less post-sphincterotomy bleeding?
@drkeithsiau
@helpatologist
@KMonkemuller
@enrrikke
@BilalMohammadMD
@tberzin
@RodriguezParra_
@drdalbir
@SunilAminMD
@GIDrDon
The bleeding is usually from the apex of sphincterotomy. U are away from PD orifice . Extremely rare where U May have to resort to glue etc. there is a paper explaining vascular supply of ampulla which is worth reading.
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If you are interested in thinking creatively about 'what's next' in
#AI
for GI endoscopy, learning about foundational models is worth the effort.
This
@Nature
paper by
@Michael_D_Moor
,
@pranavrajpurkar
,
@EricTopol
and team is a great starting point.
…
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32
90
Continued progress on self-propelling endoscopy designs by
@AgostinoStilli
+
@uclrobotics
team. Make it wireless and capable of replacing balloon enteroscopy and I am sold.
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22
88
Polyp sizing is much easier if you know the size of your devices. Spend a few minutes with a ruler & measure the *actual* size of your snare, forceps etc. [I was sent this forceps size diagram for a research project & could immediately tell that the size estimates were wrong!]
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Has anyone encountered a more recent version of this wonderful diagram summarizing the natural history of asymptomatic gallstones? (original here by the legendary Dr. Sheila Sherlock)
@SAGES_Updates
1
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@GI_Pearls
I heard Trump is blaming his loss on PPIs as well:
⬆️ PPIs use in the U.S. during last 4 years due to generalized dyspepsia
⬇️ Votes for Trump in key swing states
✅ The causal link is obvious. Add it to the warning label.
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Had to explain to a patient today that it’s really more of a “room temperature” snare than a “cold” snare.
6
5
89
Original illustration of the Goff septotomy in
@GIE_Journal
(Goff JS. Common bile duct pre-cut sphincterotomy: transpancreatic sphincter approach. Gastrointest Endosc. 1995;41:502–505)
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26
86
Next time I am tempted to speak for 59 of my allotted 60 minutes because 'I have so much to cover'..
..will remember this pic of
#Fauci
taking a sip of H20 after his *35 minute* tour-de-force Grand Rounds on
#COVID19
, leaving *25 minutes* for questions..
#lifegoals
#BeBrief
And it's time for the Tony Fauci live stream, now starting at 7 AM!
If you're not on yet, here is the link!
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87
Everyone
@BIDMC_GI
already knows that
#GirmanBrisset
('G') not only deserves this award, but utterly defines the category for an expert GI tech. For 3 decades, G has been an A+ colleague, teacher & innovator. *No one better* to help navigate a challenging endoscopic case. 🙏🙏🙏
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Pre-holiday endomucosal resections get ‘Christmas clips’ (aka Hanukkah hemostasis) because regardless of what the evidence says, a post-procedure bleed from a 1.9 cm transverse EMR site will ruin that patient’s holiday.
7
2
86
Whether or not you agree with conclusion re: needle-knife fistulotomy to reduce PEP in high-risk
#ERCP
patients (
@RKeswaniMD
's editorial = thoughtful critique)... this figure & text from
@AmCollegeGastro
is a really nice review of key technical steps:
3
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84
In aggressive expansion of EXALT product line,
@bostonsci
is first-to-market with innovative, single-use ERCP fellow [EXALT Model PGY9].
6
5
83
I ask for simethicone so consistently during procedures that our endoscopy nurses made me a Christmas ornament. 🎄 🎅
#giftideas
#secretsanta
1
3
84
Going through my files, and this stopped me cold. How much does it say about an institutional culture that its leaders would think to send a thank you note to an applicant? I remember being blown away by this after visiting
@BrighamWomens
in 2002. A good lesson for me today.
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6
83
Shout out to the naked
#zoom
bombers who showed up during my GI talk yesterday. Serves them right to land in a
#colonoscopy
lecture.
3
2
83
New academic year and new 🌟advanced endoscopy fellows
@BIDMChealth
@harvardmed
. Welcome
@pelegnoam
,
@ImanBostonMD
, &
@CPattniMD
!
1
11
82
We had colleagues visit
@BIDMC_GI
today to look at design of our ERCP suite, but they were *most* excited about our single-use device organizer which sticks on any wall and simplifies storage of multiple wires etc., freeing up clean workspace on adjacent table. (no COI)
11
12
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On a daily basis, we celebrate innovative procedures in medical journals & social media.
Today we decided NOT to proceed w/an EDGE because EUS access point was awkward, vasculature unavoidable, & risk to patient too high.
How about a journal called "When we chose caution..."
10
9
81
A useful and inexpensive trick for stabilizing the overtube during initial scope passage into the stomach during balloon enteroscopy.
Working with creative, engaged, and inventive GI techs and nurses is one of the best parts of the job.
10
15
82
Zoom multitasking fail:
Me, to my son (showing me a kids book over breakfast): “Wow! I love that you are so interested in these pictures...which is your favorite?”
Pathologist, presenting slides at our Zoom GI surgery conf: “...”
Me: [presses mute]
(Sorry
@DoktoraMalvar
!)
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Thanks everyone for the kind messages. I feel fortunate that I get to spend each day taking care of patients while simultaneously being inspired by trainees who are pushing our field towards the future. It’s not a bad deal.
👏🏾👏🏾👏🏾👏🏾Congratulations
@tberzin
on your promotion!
@BilalMohammadMD
has spoken for us. Amazing teacher, mentor, colleague and friend. World renowned gastroenterologist and speaker. Need more than 140 characters!
@BIDMC_GI
@gabr_moamen
@Boston_Endo
@harvardmed
0
0
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15
0
82
Great explanation of
#risk
I heard to today from a colleague who was consenting a very ill patient in the intensive care unit:
#patientsafety
#surgery
#endoscopy
#anesthesia
2
22
81
Not one but TWO of our recent
@BIDMC_GI
advanced endoscopy graduates are nominated for the
@HealioGastro
Disruptive Innovator Awards. Congrats to
@BilalMohammadMD
&
@AkwiAsombangMD
(and applause to all nominees, a who's who list of great colleagues).
15
19
81
510k clearance for first automated polyp-measurement tool, SCALE EYE by
@FujifilmUS
. Requires BOTH a laser-equipped colonoscope + computer vision software. Provides a linear or circular virtual measurement.
4
16
78
Mount Serratious. NASA planning mission for en-bloc removal using Interplanetary Cold Snare.
11
4
78
My
#pubmed
search ("food impaction" & "chicken") did not lead where I expected, but I read the paper anyway.
This seminal, 42 bird case series:
➡️ 40🐔, 1 🦃, & 1 goose
➡️key causes = plant material, feed, & 'misc ingesta' (tortilla, plastic, & wood shavings)
You're welcome.
10
5
79
Yesterday
@LourdesAleman4
found this at
@PorterSqBooks
and today our son is exploring gastroenterology over breakfast and my life is complete.
9
1
79
Dear residency/fellowship graduate: Next year, you will likely earn more money than this year. Here are 6 tips to help get you on the right financial path. With warm acknowledgements to
@WCInvestor
.
#investing
#savingmoney
#retirement
4
13
79
Quick method to ✅✅ biliary stricture length estimates (in this case to position SEMS for a CHD stricture just beneath hilum):
1) position balloon at top of stricture & mark catheter at instrument channel w/Sharpie
2) withdraw balloon to ampulla & measure difference
4
15
77
We have entered a new era of advertising in GI endoscopy. A
#Pixar
-inspired short with an emotional backstory. Wow. Is this happening in
#cardiology
/
#surgery
/
#IR
too?
5
19
78
Quick reminder that for small (<1cm) rectal NETs, endoscopic resection and surveillance is all that's required per
@NCCN
guidelines. (Personally, I find EUS useful for resection planning).
I still see many referred pts undergoing unnecessary CT, PET scans etc = ⬆️cost ⬆️anxiety
3
21
77
@rmulkimd
@ChahalPrabhleen
@SighPichamol
@UzmaSiddiquiMD
@ASGEendoscopy
@kmergener
@MetabolicEndo
@WomeninEndo
My best tip is to find a reliable mechanism to collect & organize each pearl, diagram, technical reminder etc into your own personal archive which you keep updated. Creating your own resource is the best way to learn. I use Evernote.
6
7
77
Reminded today of this scene, which I consider a high water mark for crazy portrayals of endoscopy, courtesy of
@GoodDoctorABC
.
CT surgeon tells trainees to "go do an ERCP" ➡️ residents quickly complete ERCP + cholangioscopy, w/creative ergonomics, under midaz. (h/t JenSheridan)
15
1
76
Someone needs to do a twitter 🧵on crazy stock photos of gastroenterologists
if the way this guy is holding the scope is any indication, there is a hospital somewhere out there in serious need of gastroenterology help
24
8
150
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10
77
Sometimes I argue that the motility of the GI tract makes interventional work in
#GI
#endoscopy
uniquely challenging...
but, this interventional cardiologist snaring a loose device in the heart...👀👀👀
h/t
@CMichaelGibson
93
313
1K
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9
77
Congratulations to all who matched in advanced endoscopy this year. Some important data for
@ASGEendoscopy
in 2019: I count 70 matched fellowship applicants, 9 women (12.8%). I can't find any specialty match with lower %. Can anyone name one? We must do better.
@WomeninEndo
16
15
73
1st report of biliary sphincterotomy,
@GIE_Journal
in 1974:
🔹hand-made device
🔹no wire -> free-hand sphincterotomy
🔹no extraction balloons -> stones must pass spontaneously 🤞
🔹specially designed insulated duodenoscope
🔹 follow-up "pancreazymin-secretin test" was normal (?)
1
20
75
Important addition to the Barrett's literature:
25% of pts referred to expert centers for LGD end up having HGD when careful Seattle protocol biopsies are performed
➡️ consider repeat mapping bx prior to RFA
➡️ LGD-->HGD progression may be overestimated
3
23
73
Discussing with our team today the
#EUS
challenge of precisely defining arterial anatomy from D1 view.
Position along CHD/CBD may help, but still difficult to definitively distinguish right hepatic artery vs proper hepatic, vs GDA.
Any tips from EUS gurus?
6
11
74