Ahmed Messallam

@drkeithsiau Looks like a Burried pumper of PEG, with a tube flush of water/saline

Endoscopic photo taken in the stomach. How would you explain this finding?

@AlmuhaidbAymen @Taalamri @alhaddad_mo @DrHasan_Orlando @NODGastro @Dr_malmadi @AALMUTAIRDI @Alghamdi_Saad_ @Badr_AlBawardy uEMR is the way to go for lesions in turns. Good job!

Case of the day: challenging endoscopic resection of 8 cm LST in the duodenal sweep (extremely unstable scope position) @Taalamri @alhaddad_mo @DrHasan_Orlando @NODGastro @Dr_malmadi @AALMUTAIRDI @Alghamdi_Saad_ @Badr_AlBawardy

@kidneymo @UMMCMedicine @UMMCMedRes @UMMCnews @UMMCacademics Wish you all the best. I’m sure UMMC will miss you!

December 16, 2024 The day this incredible group of young physicians made me feel truly special. Thank you all for this heartwarming goodbye gathering, gift, and new nickname. 🫘 👑 It means alot! @UMMCMedicine @UMMCMedRes @UMMCnews @UMMCacademics

IT'S WORLD PANCREATIC CANCER DAY! 💜📣🎗 Let's turn the world purple today to show support for those facing this disease! Here's how you can join in: 📱Put on your best purple and post on social media! Don't forget to tag @PanCAN and #PanCANawareness 💌 SHARE this post with your social media community to help spread the word 💻 Join us TODAY at 11 a.m. PT/2 p.m. ET for our webinar "Early Detection can Change the Course for Pancreatic Cancer" It takes all of us to raise awareness for pancreatic cancer! 💜 Want to do more? Donate today at pancan.org/awareness to help PanCAN fund leading-edge research and make sure every person faced with pancreatic cancer has somewhere to turn.

One should never shy away from doing what is right for our patients.

Sent a patient home last week without evaluating a concern. Decided it didn't warrant evaluation. An hour later, while typing note, I had second thoughts. Called the pt and scheduled a test. Got the results today. Very glad I did the test. A close call.

@EndoscopyOthman Agree, stick to examiantion routine. Question- Would you use one needle and go for the liver first? Or what is your approach?

EUS examination of the liver should be incorporated in every EUS performed for FNB of pancreatic mass. Every once and while you might find a liver lesion like this one in the picture below and you can do FNB of liver lesion for appropriate staging of pancreatic mass by ruling out liver mets. Remeber CT scan occasionally overlook these lesions. (weekend oncall teaching @bcm_gihep and @StLukesHealthTX )

20G PIV (left) vs 16G PIV (right) For volume resuscitation, you need a short, fat PIV, not a triple lumen CVC. Q = π Δp r^4/8 μL

@AdvaniRashmiMD @stevenbollipo @neilRsharmaMD @BilalMohammadMD @HilarHolzy @JennPhanMD @TrieuMD @shifaumarMD @JonathanBuscag1 @RabWatsonMD @JJFordeMD @SultanMahmoodMD Spy bite alongside the tome? I’ve found that a game changes for these kind of papillae if conventional cannulation methods fail.

🚨 GI friends who perform ERCP… How would YOU cannulate this? A great case that couldn’t have been done without a trusty companion. Can you guess what I used? Hint: 👁️ the wire used in the subsequent pictures after we get some commentary #GItwitter

@DouglasAdlerMD @Medtronic What about that small ulcer at 10 sec? These usually don’t heal and biopsies are negative for adeno but RFA’ing over that concerns me for recurrent buried Barretts.

14 cm circumferential Barrett's esophagus with low grade dysplasia. Time for RFA! #gitwitter #medtwitter @Medtronic

@DouglasAdlerMD I’ve seen those migrate from the pylorus. Do u fix?

Here is a tricky one. Axios is the Pylorus for gastroparesis with some degree of pyloric stenosis. Pt with limited response to botox, not a candidate for meds or GPOEM. I have had done this before to good effect. What do you think? #gitwitter #gastroparesis.

@Belenmm271 Do you puncture with that set up with needle saline primed? Or with stylet then exchange and aspirate ? Which you think causes less air? Thanks

Do you use anything similar?

#AirEntry on the biliary access during material exchange in an EUS-guided #Hepaticogastrostomy and an easy way to avoid it Thread 🧶⬇️

@drkeithsiau Ice water. It will make it will make the clip softer as it’s nitinol, and hopefully can be removed. The ice water may also help numb the finger and decrease bleeding too!

What would you do if this happened to you?

@DouglasAdlerMD @Naif_87 @MeritMedical I always de-epithelialize with APC prior to stenting any fistulas. Is that your practice as well?

@Naif_87 @MeritMedical We see these often and in this setting they are often refractory. pubmed.ncbi.nlm.nih.gov/30598588/

Chronic esophagorespiratory fistula s/p esophagectomy. Pt with many comorbidities. Stented with a 19x100mm Endomaxx stent to good effect. #gitwitter #surgery #esophagus #medicine @MeritMedical

@drkeithsiau My guess is a villous adenoma in the colon given the smooth closer area

Where do you think this photo has been taken?

@ahmad_madkour @alerepici @AkwiAsombangMD @Taalamri @EndoscopyOthman @EHolzwanger @SunilAminMD @EndoCollabcom @ASGEendoscopy Very impressive! Can you share the dissection strategy for this? Distal/proximal/tunnel? Traction method?

It’s not surgical specimen It result of ESD for 33 Cm anorectal LST ✌️ The fun of interventional endoscopy Greetings from Egypt😎@alerepici @AkwiAsombangMD @Taalamri @EndoscopyOthman @EHolzwanger @SunilAminMD @EndoCollabcom @ASGEendoscopy

@DouglasAdlerMD AIP?

10cm, almost entirely solid pancreatic mass. Very atypical. #gitwitter #EUS

@drkeithsiau Looks like a "moving tape" to me

Finding on colonoscopy. What’s the diagnosis?

@DouglasAdlerMD Spy bite frenulum pull technique. Works like a charm for cannulating redundant papilla as well. Should be able to expose this nicely.

Papilla barely visible behind a large, draping fold. What is your favorite way to manage? Pt needs sphincterotomy. 😃 #gitwitter #ercp

@docdhir Nice image. One must exclude patients transplant candidacy or get transplant hep involved in MDTB prior to such biopsy though as this may exclude transplant as a treatment modality if tumor location appropriate.

EUS Bx of hilar lesion is challenging and becomes practically impossible if there is SEMS in situ. This pt came to me after SEMS placement and negative bx. Luckily we found lesion involving LHD #GITwitter