EUS & ERCP Master

Advanced Therapeutic endoscopy educational platform

[Nitin Jagtap @miNitinjagtap]

50mg rectal indomethacin = 100mg #PEP prevention?
New RCT says yes — for most patients.
But if history of #pancreatitis? Risk difference: +18.4% favoring 100 mg. @endoscopyjrnl @ESGE_news #GITwitter #ERCP #Endoscopy @ASGEendoscopy @drsridhars @drhrr
https://t.co/PiQFr9Mq5M

[Achintya Singh, MD @AchintyaSinghMD]

An 8 cm stent may not remain 8 cm after deployment!

A crucial concept in stent selection: Foreshortening

Most commonly used SEMS are braided (e.g. WallFlex).

As they expand, they shorten in length—sometimes by as much as 40%.

In contrast, laser-cut stents are fashioned from a single metal tube and exhibit minimal foreshortening.

The tradeoff? Greater axial force and often more patient discomfort.

[UEGJ @UEGJournal]

🛠️Structured training helps junior #endoscopists master EUS-GE with the WEST technique

🔸Technical success 99%
🔸Clinical success 96%
🔸Adverse events 6%
🔸Senior backup ↓ after 30 cases
🔸Fluoroscopy use ↓ plateauing after 70

📖 #OpenAccess 👉 https://t.co/vHfPMdlCqy

[Edgar Julian Ferreira Bohorquez @Ferreira_gastro]

Paciente que debutó con esta lesión en cola de páncreas. En la EUS se aprecia su componente sólido. Nótese la cercanía con la glándula suprarrenal izquierda.

[EUS & ERCP Master @GIscope_updates]

🔴 EUS-GB drainage

✅ https://t.co/r4N5cEOev6

[Tyler Berzin MD, FASGE @tberzin]

The biliary "variant" framework undersells how individualized biliary anatomy actually is. Unlike vertebral count or hepatic arterial trunks, bile ducts develop via stochastic branching morphogenesis. Every cholangiogram is one of a kind.

Thank you for coming to my TED talk.

[Joaquín Rodríguez | 🔎Endoscopia digestiva @joakirodriguez]

Si haces EUS-gastroenterostomía en estenosis duodenal infranqueable: ocluye el píloro con balón para distender el asa yeyunal. Facilita colocar el LAMS. Detalle técnico que marca la diferencia.

🔗 https://t.co/mf7Q1fCZuK

#EUS #Gastroenterostomía #TipEndoscopia

[Edgar Julian Ferreira Bohorquez @Ferreira_gastro]

Dos casos de coledocolitiasis diagnosticados por ultraaonografía endoscópica , luego de resultado de resonancia negativo y persistencia de sospecha diagnóstica .

[Endoscopy Journal @endoscopyjrnl]

EUS-guided transpapillary vs transluminal biliary stenting: randomized comparison of long-term stent patency

Find the article at: https://t.co/L14GQux3th

Vinay Dhir et al.@ESGE_news
@docdhir

[vinay dhir @docdhir]

28/F with 2.4 cm cyst in head of pancreas. EUS shows a nodule within cyst which takes up contrast. Biopsy shows abundant mucin and columnar epithelium. MPD is not dilated. Surgery or observe?

#GITwitter

[Edgar Julian Ferreira Bohorquez @Ferreira_gastro]

Como que tremendo nódulo mural ??

[GIE @GIE_Journal]

Chong et al compare "Contrast-enhanced endoscopic ultrasound versus conventional endoscopic ultrasound–guided fine-needle biopsy with macroscopic on-site evaluation for solid pancreatic lesions: a multicenter randomized trial." https://t.co/fmLlASZWYU

#GITwitter

[Douglas G. Adler MD, FASGE, FACG, AGAF @DouglasAdlerMD]

Nice video from a freehand EUS guided gastrojejunostomy in the setting of malignant outlet obstruction.

We did a NAJA assisted EUS GJ this week (first EVER in the state of Colorado!). Suspect NAJA will be preferred way to do these.

#gitwitter #surgery @bsc_endoscopy @KristenHaeck

[Edgar Julian Ferreira Bohorquez @Ferreira_gastro]

Drenaje transgástrico con stent de doble aposición, por colección pancreática posterior a pancreatectomía distal

[Julie Hallet @HalletJulie]

🦓PanNETs @BJSurgery Commission: G3 PanNENs

🔬G3 NET vs NEC is EVERYTHING
🧬Molecular profile (MEN1, DAXX, ATRX) can help risk-stratify
🔪Surgery only for highly selected localized G3 NETs
⚠️Recurrence expected: systemic therapy 1st

🔗https://t.co/fqS90z6MkO

@spartelli

[Julie Hallet @HalletJulie]

🦓PanNETs @BJS_Surgery Commission: surgery in NF PanNETs >2 cm?

>40% recur within 5 yrs‼️
🔬Need to define "borderline resectable" biologically, not just technically
💊Preop therapy 🔑 to test biology & downstage

🔗https://t.co/fqS90z6MkO

@spartelli

[Julie Hallet @HalletJulie]

PanNETs @BJSurgery Commission: operate on small NF PanNETs ≤2 cm?

⏱️With typical features - observation safe
📊PANDORA & ASPEN: rare progression, no survival compromise
🔪Surgery for atypical features (MPD⬆️, heterogeneity, ⬆️nodes)

🔗https://t.co/fqS90z6MkO

@spartelli

[Achintya Singh, MD @AchintyaSinghMD]

EUS liver examination: Portal pressure measurements

1. Targets are portal V, Hep V from the stomach (see prior tweets on identification).
2. Use 25G FNA needle, heparin flushed, 3 measurements.
3. We prefer umbilical portion of PV, middle hepatic vein for measurement.

[Achintya Singh, MD @AchintyaSinghMD]

Continuing our liver journey:

After identifying Middle Hepatic vein (prior tweet), pull back, clockwise torque-->
1. Right hepatic vein branching from the IVC
2. Segments 1, 7, 8 are identified

All the targets for portal pressure measurements are visualized (more soon!)

[Achintya Singh, MD @AchintyaSinghMD]

EUS exam of left liver continues along left portal vein

1. From umbilical portion of PV-> Clockwise torque
2. Reach Ligament Teres: Hyper echoic, connects PV to IVC
3. Push in, visualize middle hepatic vein: "Elephant Trunk"

With this entire left lobe is examined!