Danny Galloway

Any gastroenterology or surgical trainees interested in a research fellowship @StMarksHospital @stmarksbcsc in #LynchSyndrome and #Colonoscopy please get in contact, thanks! @BSGTrainees @Dukes_Club @ImperialSandC

New research - Bang et al - Upfront endoscopic necrosectomy or step-up endoscopic approach for infected necrotising pancreatitis (DESTIN): a single-blinded, multicentre, randomised trial thelancet.com/journals/langa… #GITwitter #Pancreatitis

@NEndoscopy @SahajRathi @Srisha_Hebbar Great read thanks John 👍 I think that 2/3 figure may hold up today if relying on scan report of reporting general radiologist, but if asking your ‘go to’ HPB radiologist today to report can’t believe it would be that high.

@PBEndoscopy @SahajRathi @Srisha_Hebbar Hepatogastroenterology. 2011 Nov-Dec;58(112):1862-5. doi: 10.5754/hge10531. Bit of an older study. Our experience is we find a soft tissue mass in about 2/3rds even without CT mass. EUS then confirms a mass and sans stent can accurately stage. Often on a vessel so Bx…

Indeterminate biliary strictures can be difficult to solve Fluoro guided duct bx gives good yield, and is inexpensive. Excellent addition to brush Cholangioscopic bx can be the next step What are your tips for good fluoroscopic intraductal biopsies #GITwitter?

@NEndoscopy @SahajRathi @Srisha_Hebbar You may’ve already answered indirectly in that if operable you wouldn’t EUS but do brushings / SpyBite. I think Fluoro-guided endobiliary Bx can be done safely with excellent results. Gonna start reviewing a few years of data with SpR for our cases.

@NEndoscopy @SahajRathi @Srisha_Hebbar What’s the sensitivity without imaging evidence of significant soft tissue abnormality / mass / node on CT or MR John? Do you get a good pick up rate with FNB without above and just a bit a wall thickening when u do EUS?

@SahajRathi If associated mass lesion, or if stricture level of intrapancreatic CBD would always do EUS in same sitting prior to ERCP.

@SahajRathi Do it as routine if imaging looks like primary ductal lesion. Keep GW in situ to guide re: line, needs adequate sphincterotomy, advance ~15mm out of scope then initial engagement of forceps into duct with scope manoeuvres only using endo and fluoro guidance to ensure good line.

@NEndoscopy @AnandSahaiEUS Was there downstream duodenal obstruction John causing a degree of a sump in duodenum with stasis and then reflux thru LAMS?

@AnandSahaiEUS Not really sure about more but there are more options for a tubular biliary stent over a short LAMs eg RFA. Had a few patients that kept developing biliary infection even with a plastic through the LAMs. Obvs have had blocked biliary stents too…

If the Axios stent was the same price as a standard biliary stent, I wonder if people would generally favor EUS over ERCP for distal MBO; since EUS can also provide highly accurate tissue diagnosis and staging at the same time as biliary drainage.

@Srisha_Hebbar @GIscope_updates @SahajRathi @SunilAminMD @NEndoscopy @helpatologist @DrLakhtakia @ChahalPrabhleen @TarunRustaGI_MD @Taalamri @dredgodfrey What’s your experience re: these patients getting cholangitis when LAMS placed immediately upstream of a degree of duodenal obstruction?

Primary CDS - Naonegenerian. Ampullary lesion with liver mets. When the duct size is 2 cms, and scope in a stable position, no messing around here. Straight to 6x 8 mm LAMS and out! #GITwitter

Got asked to help out with a nice EMR this week. I've become a big fan of Tip-In EMR for certain polyps. Are you using it in your practice? What would have been your resection strategy of choice on this polyp? @BilalMohammadMD @EndoscopyOthman @RobertBechara @neilRsharmaMD

One of my favorite attendings from med school gave me advice that I still think about to this day. Over the past 5 years of residency, I've adjusted some items to be more applicable to a surgery resident so here is a 🧵of Dr. Touss' 5 rules of 💩 (w/ surgical modification) ...

@javlatif @PBEndoscopy @DerbyPBunit @Innov_Medicine @SAGES_Updates @MISIRG1 @BehindTheKnife @IHPBA @rbarbosa91 @altaf_awan12 @MedicalAdv @imedverse IMV this work should not be underestimated and I believe dedicated benign centres should take an interest and push for excellence to achieve better outcomes. Societies such as @GBIHPBAnews @Augishealth should promote and trainees should do fellowships like @DerbyPBunit

@ib9994 @javlatif @DerbyPBunit @Innov_Medicine @SAGES_Updates @MISIRG1 @BehindTheKnife @IHPBA @rbarbosa91 @altaf_awan12 @MedicalAdv @imedverse @GBIHPBAnews @Augishealth @GutsCharityUK Exactly that.

@PBEndoscopy @javlatif @DerbyPBunit @Innov_Medicine @SAGES_Updates @MISIRG1 @BehindTheKnife @IHPBA @rbarbosa91 @altaf_awan12 @MedicalAdv @imedverse @GBIHPBAnews @Augishealth Agree, this can only be changed by those with passion. It’s not about ego’s, it’s about the patient getting the best care. It needs help and recognition by the wider clinicians in the specialty. @GutsCharityUK

𝗖𝗮𝘀𝗲 𝗣𝗿𝗲𝘀𝗲𝗻𝘁𝗮𝘁𝗶𝗼𝗻 🔴Background of chronic pancreatitis secondary to ETOH excess 🔴Transfer from DGH following CT showing large pseudocyst 🔴Main symptoms is ongoing pain and early satiety 🔴MRCP demonstrated 11cm x 8cm pseudocyst with no DPDS and PD stone - images below 🔴Proceeded to EUS Drainage and Hot Axios insertion 🔴Good clinical outcome with symptom resolution 🔵Planned admission 6 weeks later for removal of Hot Axios stent 🔵Endoscopy and CT images below What is the Dx? WWYD?

@ib9994 @javlatif @DerbyPBunit @Innov_Medicine @SAGES_Updates @MISIRG1 @BehindTheKnife @IHPBA @rbarbosa91 @altaf_awan12 @MedicalAdv @imedverse @GBIHPBAnews @Augishealth Absolutely. IMO pancreatitis patients get a rough deal, nobody wants to own, they need A team be it medical/surgical with an interest in the disease to own and manage. Unfortunately we are miles away from this in the UK at present.

@DerbyPBunit @Innov_Medicine @SAGES_Updates @MISIRG1 @BehindTheKnife @IHPBA @rbarbosa91 @altaf_awan12 @ib9994 @MedicalAdv @imedverse Re: this case. Reminds me of a lost LAMS (duodenal puncture) as an SpR within PPFC. 2 years later comes back for ERP for ongoing CP pain, scope down - LAMS now visible in D1 lumen easily removed

@DerbyPBunit @Innov_Medicine @SAGES_Updates @MISIRG1 @BehindTheKnife @IHPBA @rbarbosa91 @altaf_awan12 @ib9994 @MedicalAdv @imedverse Fascinated by the work you guys at Derby are doing re: WOPN / PPFC drainage. Not reflected by surgeons in my region: keep pushing the education 👍

Simple analogy of alcohol liver disease vs hepatitis C: - Not detecting alcohol underreporting is like using a HVC test with many false negatives. - Not treating underlying alcohol use disorder, it’s like denying antivirals to HCV patients. #livertwitter #MedTwitter @EASLedu

OPTIMAL-IPMN officially up n’ running! We need to stop resecting IPMN with low grade dysplasia. Can we push time-point for resection? Join us to find predictors for resection or surveillance! docs.google.com/forms/d/1FOhqS… @poyaghorbani @HpbKarolinska @EAHPBA

@cparisinos @pbendoscopist Good memories Costas!

@pbendoscopist We have a fire alarm in the ercp room that goes off just multiple times a week, and often goes on for the whole procedure - its like medicine in a battlefield

Doing biliary endoscopy amid NHS chaos is so stressful I’ve resorted to putting easy listening music on headphones between cases. Thank god for Chris De Burgh

Risk of main duct dilatation in mixed-type IPMN 🌿 in @AGA_CGH Risk of cancer at 2 and 5 years: ⚠️ 5-9 mm ➡️ 8% and 10% 🚨 > 10 mm ➡️ 16% and 33% 🔥 Hot topic at @EurPancClub 2023 and for the upcoming guidelines !!! cghjournal.org/article/S1542-…