Yi Yuan Tan

Gastroenterologist with an interest in IBD

[Malcolm Tan @IBDGastroDocSg]

The Mesenteric Excision Debate in Crohn's Disease: SPICY vs. MESOCOLIC. ✂️

1/ To resect or not to resect the mesentery? 🤔We finally have prospective RCT data. #IBD #ColorectalSurgery #Gastroenterology

[Malcolm Tan @IBDGastroDocSg]

How intestinal ultrasound (IUS) changes IBD care – clinical impact, cost savings & greener healthcare

1/ #IBD is rising fast in SE Asia 📈
We need tools that are accurate, patient-friendly, and sustainable.
Our SGH pilot study shows #IntestinalUltrasound ticks all 3 boxes ✅

[Mohamed Othman @EndoscopyOthman]

Underwater EMR is helpful in delineating the borders of small periappendceal polyps. This allowed en bloc and R0 resection as seen in this video

[Yi Yuan Tan @Yiyuan_Tan]

Nice summary of current therapies for EoE - with the ESO-101 delivery system (ACESO trial, phase 2) and Cendakimab as newer agents to watch along pipeline!

[Yi Yuan Tan @Yiyuan_Tan]

@hsid_h https://t.co/bIjHtFrDTM
https://t.co/JwZa4tpORq.1053/j.gastro.2020.03.073

Here you go!

[Yi Yuan Tan @Yiyuan_Tan]

Progress towards personalised #IBD therapy will require granularity re: genetic contributions, with a push for 4 digit HLA resolution.

Risk of Anti-TNF immunogenecity (mitigated by IMM):
DQA1*05:01 - IFX
DQA1*05:05 - IFX , ADA+
DRB1*01:02 - ADA ++

#IBDTwitter #GITwitter

[Malcolm Tan @IBDGastroDocSg]

S2S vs E2E anastomoses in Crohn's disease
- retrospective series (n=127)
- similar rates of endoscopic recurrence
- lower surgical recurrence with S2S

Possible reasons:
- less faecal stasis
- greater distance b/w stapler line and neo-TI inflammation

[Yi Yuan Tan @Yiyuan_Tan]

Tips and tricks for approaching the difficult colonoscopy!

On top of these, having patience and a good sense of scope torque/tension cannot be understated.

#GITwitter

[Yi Yuan Tan @Yiyuan_Tan]

Quick notes on Ogilvie's syndrome (ACPO)
- Usu. Elderly
- Sympathetic hypertonia triggered by illness/Sx
- Act early - 20% perf risk!
>higher if cecum >9cm, dur. of ACPO >6 days
- Neostigmine needs monitered setting

PEC video for ACPO! > https://t.co/CmfwJ4z9Dv

#GITwitter

[Yi Yuan Tan @Yiyuan_Tan]

IBD drugs in pregnancy:
- IgG1 can't cross placenta passively, dependent on active xport beginning 2nd trimester.
- biologics are generally safe, p19 data limited
- mean clearance time ~4-6 months
- S1P-R modulators, JAK c/i due to teratogenecity profile

#GITwitter #IBDTwitter

[Malcolm Tan @IBDGastroDocSg]

Adalimumab after treatment of luminal abscess in Crohn's disease
- n=117 (only 11 pts underwent drainage)
- max diameter of abscess = 29mm
- about 73% success at 2 years
- need for drainage a/w subsequent resection

Relevant data on a fairly common clinical scenario.

@AGA_CGH

[Keith Siau @drkeithsiau]

Management and follow-up of gallbladder polyps 💡 #UEGWeek

[Yi Yuan Tan @Yiyuan_Tan]

@divvissionbell @joanabreves Would consider tofa, ADA not so much (subcut and its efficacy in UC is not great)

[Yi Yuan Tan @Yiyuan_Tan]

Biologic-experienced pts with ASUC:
- Tofacitinib is highly effective (~60%)
> TRIUMPH preliminary results showed clinical, biochemical response < 3 days

-Cyclosporine as a bridge to other UST/VDZ

⬇️Excellent workflow by @joanabreves!

#GITwitter #IBDTwitter

[The Lancet Gastroenterology & Hepatology @LancetGastroHep]

Alain Schoepfer presents data from a phase 3 trial of cendakimab, an anti-IL-13 monoclonal antibody, for adults and adolescents with eosinophilic oesophagitis #GITwitter #UEGWeek #UEGWeek2024

[Malcolm Tan @IBDGastroDocSg]

Withdrawal of IFX in pts with steroid free remission in Crohn's.

- about 1/3 will have a relapse by 2 years
- factors: <17yo at dx, active smoking, presence of stricture, ↑ CRP, ↑ calprotectin, ↑ CDEIS
- retreatment with IFX is successful is almost all patients (22 of 23 pts)

[Yi Yuan Tan @Yiyuan_Tan]

@RenGoa63 sorry for the late response - doi: 10.1136/jitc-2020-000958

[Yi Yuan Tan @Yiyuan_Tan]

ICI-mediated duodenopathy has 2 main forms
- Celiac associated (villous atrophy, TTG+, IEL++) - possibly due to unmasking
- Duodenitis (ulcerative or villous, TTG-, IEL+/-)

Unlike CeD, ICI-mediated disease will have neutrophillic infiltrates

#GITwitter

[Yi Yuan Tan @Yiyuan_Tan]

Endoscopic features of active H. Pylori infection
- Hyperaemia
- Enlarged folds
- Sticky mucus
- Nodular gastritis - lymphoid follicular hyperplasia - biopsy to exclude diffuse type gastric CA
- Loss of RAC

#GITwitter #MedTwitter

[Yi Yuan Tan @Yiyuan_Tan]

Fundic gland polyps
- usu. small, sessile, glassy, hyperaemic
- NBI - Honeycomb, dense vascular
- Histo: dilated oxyntic glands

Mx:
> 20 - consider polyposis

Large (>1cm):
> Resect (also if antral)
> Exclude HP
> Consider stopping PPI if feasible

#GItwitter #MedTwitter