Manuel Arrieta

#TB 4 years ago, I was in my last year of med school and traveled to Japan to learn about gastric cancer, and @IntuitiveSurg Invited me to his lab in Tokyo for a full day of introduction to robotic surgery. And well... Look at my face 😍 @SAGES_Updates @MISIRG1 @SWexner @salo75

A @JAMA_current review of Gastric Cancer >50% of pts present with advanced disease with increasing cases in those <50 yrs. Mandatory biomarkers (MSI/MMR, PD-L1, HER2, CLDN18.2) now guide care, while diagnostic laparoscopy uncovers occult metastases in ~20. Management is biologically driven across stages. jamanetwork.com/journals/jama/…

@impression_ists 😍

Non technical surgical skills (NOTSS) for surgeons 👁️🔪⤵️💥! @pferrada1 @SWexner @TomVargheseJr @CiruAndes2 @juliomayol

@RobertBechara In Japan GI fellowships long rotations in pathology department, and weekly discussion with pathologists 🤯

Amazing Barrett’s conference in Nagano today. The endoscopic-histologic correlation was absolutely impeccable—left me speechless. A level of precision we need to strive for in the West

This month's Editorial: The complex cartography of cancer care "For health systems to be truly equitable, all stakeholders must collaboratively address these challenges to create a health-care landscape that serves all patients" thelancet.com/journals/lanon…

@almavbe_ 👏👏👏👏❤️❤️

@julianvarascom Exactly 👏 💯

🚀🚀🚀🚀🥳🥳🥳🥳🔥🔥🔥🔥🔥We’re excited to share our recent publication, “Innovation Meets Practice: A Scalable Simulation-based Methodology for Massive Paracentesis Training,” published in Gastroenterology. This paper details our innovative approach using simulation-based education combined with asynchronous digital feedback to efficiently train large cohorts of medical students in performing paracentesis. Our methodology demonstrates how structured feedback, even when delivered remotely by trained near-peer instructors, significantly enhances skill acquisition and student confidence. Key findings include an 85% passing rate after remote asynchronous feedback, comparable or superior to traditional face-to-face training. Notably, this model addresses common challenges such as limited availability of expert trainers and resource constraints, making it scalable and practical for wide application. We believe these insights can help educators and institutions globally improve procedural training efficiency, student preparedness, and ultimately, patient safety. Explore more about our methodology and findings here: doi.org/10.1053/j.gast… #MedicalEducation #SimulationTraining #Paracentesis #AsynchronousLearning #InnovationInMedicine #ProceduralSkills

@almavbe_ @MGHSurgery 👏👏

Hot off the press! Our latest work on advanced gastric cancer from a high-volume center in Japan is now published. Check it out: link.springer.com/article/10.100…

Cross-sectional survey on burnout/career satisfaction in @SurgEndosc: 69% of respondents are burned out; 50%+ are depressed and wouldn't become surgeons again; less than 1/3 had time for family and personal life. Let's make it better! link.springer.com/article/10.100…

@RobertBechara 👏👏 I will add always keep washing and washing. Just like the video shows

Hey #GItwitter, this case demonstrates some important points during EGD: 1. Don't rush! Take a few more seconds passing GEJ and retroflexion as GEJ lesions can be easily missed. 2. Make sure to insufflate the stomach adequately to be able to thoroughly examine the GEJ

@EndoscopyOthman One thing I have noticed in Japan, even experts (>1000 ESD) at least I can say 2 times in a month they still do simulation of ESDs, especially when they face difficult locations

In the last eight years, I was honored to help many endoscopists to start their ESD practice. One of the observations I noted is that endoscopists gain sufficient ESD skills and perform around 20 to 30 cases before they start scheudling the procedure intermittently and infrequently. Although lack of CPT code can contribute to this. Another major reason is the unrealistic expectations related to ESD learning curve. In the July issue of @endoscopyjrnl (EIO) @MaiKhalaf183023 and our research team at @bcm_gihep studied my learning curve of ESD for my initial 503 cases. I did not learn ESD during fellowship and my experience is similar to any one currently in practice who aspires to add ESD to their skill set post formal training. Our team found the following: # I needed 265 cases to achieve reliable en bloc resection 90% of the time consistently # I needed to 347 cases to reliably achieve 80% or above R0 resection rate consistently # I needed 170 procedures to achieve a resection speed of 9cm/hr consistently *This place competency in ESD in a number between 250 to 350 procedures My reflections on this study: 1- Competency for advanced procedures such as ERCP and EUS are assessed after 180 and 250 procedures respectively. ESD is in the same category and the expectation to master the technique after 20 to 30 procedures is not realistic. 2- Unlike ERCP where you either cannulate or not, there are some leeways after incomplete ESD. Combing ESD with EMR is an option for benign lesions or additional salvage ESD by another expert later on for positive margins. ESD learners should not be discouraged by the long learning curve for ESD 3- ESD is a life long skill, you will continue to evolve and improve with time. You should deal with ESD frustrations the same way you deal with post ERCP pancreatitis, you learn your lesson, move on but never quit!! thieme-connect.com/products/ejour…

@Gio_Marchegiani @JSHBPS @hitoen9 @me4_so @hpb_so @Some4SurgeryIT1 @T4UGIS @roux_group @BJSAcademy @young_bjs In gastric surgery they make 3D reconstruction of vascular anatomy to make the lymph node dissection 🇯🇵🇯🇵🇯🇵

🇯🇵 Mastering the dissection of the first jejunal branches during pancreatoduodenctomy 🏣 Japanese surgeons secret weapon: sketching the anatomy of each case before surgery!

@lramirez869 Ya he visto a más de uno

Ver a la única persona logró hacerme llorar en mi residencia, ahora abogar en redes sociales en contra del maltrato en la formación médica. En fin, la hipocresía

@HuberPadilla1 Felicitaciones hnoo. Exitosas

Hoy es un cumpleaños particular, pero en un país donde quiero cumplir muchos más!

Endoscopy and Antireflux Surgery: A Technical Review of Pre- and Postoperative Evaluation and Recognizing Patterns of Failure 📕Read Here 🔓Open Access: journals.sagepub.com/doi/full/10.11… #GITwitter #MedTwitter @AHNesophagus @AHNSurgeryInst @Dunn4Gut @Sayazi @SvenESEriksson @JobeBlair

1/6 Today I gave 5 pieces of advice to our new @UMichSurgery interns. First I asked them if they had a culture. “Not yet” I suggested they would soon and when they were chiefs, they would own the culture of the residency. They will create it starting now. So my 5 tips👇

La primera mujer en ganar una elección popular a la gobernación de Sucre @LucyGobernadora Who run the world? GIRLS! 🫶🏻 I N M E N S A

Lo vamos a lograr! ✅🫶🏻💥 @LucyGobernadora LA PRIMERA 🔝

This week's webinar is part of our popular 'Back to Basics’ series: How to perform a structured EUS 📅Weds, Sept 27 ⏰19:00 CEST Join dream team experts @paris_golfakis @KM_Pawlak & Schalk Van Der Merwe by registering for free here: us06web.zoom.us/webinar/regist… 🧵⬇️