EndoCollab™ | GI Endoscopy Community

Respect the plane. Standard polypectomy is a mucosectomy. EMR and ESD work through the submucosa. That distinction changes everything about resection quality. At what point in training did the plane click for you?

Endoscopic full-thickness resection: removing the entire GI wall thickness -- endoscopically. Non-lifting lesions, subepithelial tumors, or selected early cancer -- where does EFTR add the most value?

You're clipping a Mallory-Weiss tear. Where do you place the first clip? Most endoscopists start proximally — closest to the scope. Seems intuitive. But there's a better approach: place the first clip distally (furthest from the scope). Then work proximally. Why this matters: Starting distally gives you an unobstructed view for precise placement. If you start proximally, the first clip blocks your view of the distal end and makes subsequent clips harder to position. The result: a stable V- or Y-shaped closure pattern that provides secure hemostasis. This simple change in clip sequence — distal to proximal — turns a frustrating clip job into a clean, reproducible closure. From The EndoCollab Guide for GI Bleeding By @theendoscopist

Cronkhite Canada Syndrome (CCS) thepracticingendoscopist.com/p/cronkhite-ca…

Portal vein thrombosis: anticoagulation may reduce mortality, but at the cost of more bleeding. What tips the decision for you in borderline cases?

Build the bump, then close. Creating a tissue mound before clipping gives you something to grab. Simple move, cleaner closure.

Non-lifting adenoma of the transverse colon. When injection fails to lift, EFTR can be organ-preserving where surgery used to be the default. How many failed lift attempts before you change strategy?

Iron deficiency can affect tissues before the hemoglobin falls. Cold intolerance, restless legs, pica, hair loss, and brittle nails may be early clues.

Quick Case: Laterally Spreading Tumor LST in Ascending Colon thepracticingendoscopist.com/p/laterally-sp…

Foreign body removal with the Mega Cap. When the object is large, sharp, or unstable, cap assistance can change control and extraction strategy. Which foreign body makes you reach for it fastest?

When approaching dilation for dysphagia, a thorough differential diagnosis is crucial. Knowing when *not* to dilate, as in cases of permanent strictures, is as important as selecting the right equipment.

Follow the varix, not the panic.

Resect-and-close: the pure EFTR concept. If the perforation is intentional and closable, it changes how you think about the case. Where do you see the practical limits of this approach?

Stapfer II perforation after intervention for a bile leak in a postpartum patient. When do you push for endoscopic rescue vs send directly to surgery?

Anastomotic strictures, particularly post-gastric resection or esophagectomy, respond well to incisional therapy. The technique involves circumferential incision and resection of fibrotic tissue using knives like the IT or needle knife.

OTSC Pyramid of Tissue — the concept behind successful EFTR. Pull the tissue, don't suction. What mistake most often ruins cap capture in your hands?

Laterally spreading tumor (granular) — LST-G. These nonpolypoid lesions can still harbor cancer. What drives your resection plan first: size, nodularity, pit pattern, or location?

Key Steps of the Full-Thickness Resection Device (FTRD) 1. Find lesion 2. Catch with forceps 3. Pull into cap 4. Release clip 5. Resect above clip Which EFTR step do you think is most often missed?

Snare tricks to avoid piecemeal resection