Aleksandar Gavric

@KMonkemuller @GI_UMCLJ Thank you vey much. I would be happy to help.

@GavricAle @GI_UMCLJ I’m writing and editing a book on endoscopic resections and would be very honored to have you and your colleagues contribute with this mini-atlas

"Twitter Endoscopy: A Mini Atlas of Gastric Dysplasia" Here I share some of the dysplastic lesions referred for endoscopic resection at @GI_UMCLJ 1. Antrum, low grade dysplasia. Removed via ESD. Specimen 43x32mm / dysplasia 20x13mm. R0

@KMonkemuller @GI_UMCLJ Thank you :) Will add more in the following days.

@GavricAle @GI_UMCLJ Nice Atlas ✅ 👏🏻

7. Antrum, posterior wall. Removed via ESD (Dr. Plut S.), LGD. Specimen 27x27mm / LGD, R0

6. Antrum bellow the angular fold. Removed via EMR en bloc (by. Dr Plut S). LGD Specimen 35x21mm / Low grade dysplasia.

Nice reminder to check distal duodenum (if possible) during emergency egds in patients with melena.

Retirement reflections #5 Many medical experts spend more time lecturing around the globe on their expertise than they do at work. This makes them experts on theory not practice.

@drkeithsiau Do you have post EMR defect image? Prophylactic closure (cecum and DOAC).

This was delayed post polypectomy bleeding with a large overlying clot. The patient had a polypectomy 1 week prior and was on a DOAC, and was admitted with shock. CT angio had shown active bleeding from caecum, in keeping with a recent polypectomy site. Management (after stabilisation): 1. Unprepared colonoscopy 2. Adrenaline injections to base 3. Snare removal of clot 4. Clips x6 (due to awkward position) 5. Purastat When there is severe colonic bleeding with a clear target, salvage colonoscopy is possible without bowel preparation and can avoid surgery.

Seen in the caecum in a patient with a massive lower GI bleed. What would you do here?

Patient no.49 was recruited at @GI_UMCLJ @ukclj for ERADICATE trial. The lesion was randomised to the margin marking before hpEMR. @GavricAle @DennisYangMD

Compared with adenomas, sessile serrated lesions are rarer and can be more challenging to detect. Here I share "twitter SSL Endoscopy Mini Atlas" of the lesions I encountered during some of my endoscopies. 🧵

@SN_gastro Thank you. Depends, prefer cold for <20mm and OIIb. Recently do it more often though.

@GavricAle Nice tread! I love it! Some you cold snare some are 🔥. Size determines? :)

@AndresSilva182 Initially was thinking to go for eftr, but access was good, scope stable so went with the esd. Ct and gallium pet pending then we will decide.

@GavricAle Close surveillance and maybe CT-PET with Gallium 64 to evaluate any residual activity. Maybe in this specific scenario intermuscular ESD it's more appropriate. Even though the in block resection is very useful for stratification.

This is NET G2, Ki67 6%. Lesion was removed via ESD. Despite macroscopically R0 resection, path analysis did not confirm R0 due to thermocoagulation artefacts at the base.

How to examine papilla with a distal cap-fitted gastroscope. youtu.be/FCcxZT_IBJ4?si… How do you examine papilla in patients with polyposis syndromes? Duodenoscope or gastroscope with a distal attachment cap?