Adel Hassan Alam

Gastroenterology/Internal Medicine consultant

[Achintya Singh, MD @AchintyaSinghMD]

We should know the gravity (dependent) side of the lesion before starting resection, why?

Compare ESD to removing a door from its frame.

Which part is hardest to remove?

The side attached to the hinges.

In ESD, think of the gravity (dependent) side as the hinge.

If you start dissecting from the anti-gravity side, the specimen falls toward the dependent side—making the “hinged” portion progressively harder to access.

🏦So remove the screws first.

🔑 Start your mucosal incision/dissection from the GRAVITY side.

As the lesion becomes free, gravity can then work for you rather than against you.

So after the correct incision, more of the submucosa will be exposed.

PS: This is my understanding, not endorsed by anyone (including ChatGPT)

[Adel Hassan Alam @adel_H_A]

@Neduszn8 Kolo Touré and Jermaine Pennant

[Ash Almomani, MD @AlmomaniMD]

Methylene blue is the best agent for gastric #chromoendoscopy. It gets absorbed by the intestinal metaplastic cells and cannot be washed out, unlike in the colon.

Because it also gets absorbed by normal intestinal cells, patients will pee blue that day💧

#medtwitter #gitwitter

[Rabih Ghazi, MD @Rabihghazi_95]

Endoscopic Bariatric and Metabolic Therapies (EBMT)

EBMT + Lifestyle Modification recommended for:
🔸BMI ≥ 30 kg/m2
🔸BMI 27.0 - 29.9 kg/m2 + at least 1 obesity-related comorbidity

@ASGE - @ESGE_news 2024 Guideline

#MEDTwitter #MedX #MedEd #GITwitter

[Adel Hassan Alam @adel_H_A]

@AAlSharydah عمل جبار جزاك الله كل خير ❤️

[د. عبدالعزيز الشريدة | Dr. AbdulAziz AlSharydah @AAlSharydah]

✨ إنقاذ حياة لهذا الإسبوع:

🧓 مريضة مسنّة.
التاريخ الطبي: تليف الكبد وسرطان الخلايا الكبدية 🦂 (Child C، MELD 18).
عانت من فقر الدم، ونزف معوي تغوطي (أعزكم الله)، وقيء دموي🩸.
أظهر التصوير المقطعي دوالي المعده متضخمة.
كشف المنظار عن نزيف نشط في الجهاز الهضمي العلوي 💢.
تم إحالتها إلى الأشعة التداخلية والقسطرة ☢️، وتم إجراء💉 غلق وريدي عكسي بإستخدام البالون الطبي ولفيفة معدنية والحقن بالصمغ الطبي🧪 (BRTO/CARTO) بنجاح.
توقف النزيف من الجهاز الهضمي العلوي في اليوم التالي بشكل كامل ⚕️.
خرجت المريضة إلى المنزل بصحة جيدة 🪩.

يستطيع تخصص الأشعة التداخلية المساعدة دائما❗

#الأشعة_التداخلية #سرطان_الكبد #دوالي #المعده #المناظير

[ℝ𝕠𝕔𝕜𝕖𝕥𝕄𝕒𝕟_𝕊𝕡𝕒𝕔𝕖 @pexkewn]

✂️ Polypectomy tips

✅ Loop for very thick stalks

https://t.co/irFTLt3vlh

[Andy Tau, MD @DrBloodandGuts]

To cover a bleeding point (varices) or perforation, sinply deploy at cardia , and pull back scope in 1:1 fashion. Don’t even need to touch the catheter.

[Andy Tau, MD @DrBloodandGuts]

At TSGE: checkout the ⁦@bostonsci⁩ Agile TTS FCSEM stent.

5 years ago new covered metal stents were made to pass through the scope (tx gastroscope 3.7 mm), allowing for direct visualization , no need for fluoro! Great for refractory variceal bleeding @ ICU!

#GITwitter

[ℝ𝕠𝕔𝕜𝕖𝕥𝕄𝕒𝕟_𝕊𝕡𝕒𝕔𝕖 @pexkewn]

✅ Gurvits syndrome 🔥

[EndoCollab™ | GI Endoscopy Community @EndoCollabcom]

Mastering ERCP technique:

A critical anatomical review.

• Pancreatic duct stent integrity confirmed
• No sphincter laceration observed
• Key anatomical structures:
- Bile duct
- Pancreatic duct
- Septum

Optimal positioning: Duodenum to left on screen (anatomic right) for accurate cannulation and imaging correlation.

[Andy Tau, MD @DrBloodandGuts]

The @STERISEndoscopy Raptor grasping forcep can rotate. If you place a 30 degree “bend” it rotates/ reaches more angles than before in endosocpy.

Laparoscopic instruments have this bend and for good reason! Look to your surgical colleagues for innovation!

#GITwitter

[Keith Siau @drkeithsiau]

The evolution of gastritis 🔥

[Keith Siau @drkeithsiau]

The pancreas when touched during ERCP 😅

[Adel Hassan Alam @adel_H_A]

@AAlSharydah ماشاءالله تبارك الله
ألف ألف مبروك كلنا فخورين بك 🤍🤍
منها للأعلى بإذن الرحمن
وترجع لنا سالم وغانم

[Tom Tielleman, MD @TomTielleman]

I always encourage the gen GI fellows to join during ESDs as there’s a lot of tools/tricks to learn

Example: Control of active bleeding w coag grasper
✅ Irrigate continuously to locate the spot
✅ Grasp - bleeding should stop if you’ve got the vessel
✅ Pull away gently & burn

[Adel Hassan Alam @adel_H_A]

@MFaraidy ماشاء الله تبارك الرحمن🙏🏼
ألف ألف مبروك ومنها للأعلى بإذن الله تعالى🌹
الله يزيدك علم وينفع بك البلاد والعباد
وترجع للوطن بالسلامة♥️

[Adel Hassan Alam @adel_H_A]

@DrMdhawi ماشاءالله تبارك الله، ألف ألف مبروك عبدالله ومنها للأعلى🌹

[Carl Kay, MD @CarlKayMD]

Luminal Strictures

▪️Benign vs. malignant
▪️Simple vs. complex
▪️How to estimate lumen size
▪️When to suspect complications
▪️“Rule of 3s”
▪️👀post-dilation heartburn
▪️French scale
▪️Definition of refractory & recurrent
▪️Endpoints 🥅
▪️Types of dilators & adjuncts

#GITwitter

[Turki AlAmri |تُرْكي عبدالله الْعَمريَّ MD @Taalamri]

🔴 Approaching large Pedunculated polyp; Ip.with thick tortious stalk in duodenum D-2.
✅️Two clips at the base
⛔️EPINEPHRINE
✅️Pure Endo-Cut
➡️Teaching point ; applying forced coagulation in polypectomy associated with increase risk of post polypectomy syndrome.
Great help by⭐️ @IbrahimAlhafid @RaedAlsulaiman
Interested to know your approach dealing with large Pedunculated polyps ?
@drkeithsiau
@CarlKayMD
@ahmad_madkour
@alhaddad_mo
@BilalMohammadMD
@Rquezadap
@neilRsharmaMD
@Ferreira_gastro
@TrieuMD
@Endoscopist4
@DharJahnvi
@JJFordeMD
@flaubert_sena
@SyedGerdezi
@stevenbollipo
#Basics
#Teaching
#AdvanceEndoscopy