Dear colleagues, EBGI needs your help to reach 100 final survey responses Whether OR NOT you use social media for GI mentorship and career advancement, we still need your voice. We would be very grateful if you can fill today & share w/ colleagues 🔗 https://t.co/l4nMBae6J1

1/ ⏰ for #EBGI Tweetorial🧵w/ @nataliejowilson! “Does Prophylactic Clipping Prevent Delayed Bleeding After EMR of Large Proximal Colonic Polyps?” 📜Summary https://t.co/c0f2vHVtTz 📰Article https://t.co/AB8P0PwH6w

@JassimranSingh9 @anoushkaduaMD @halesj126 @RomyChamoun @noorannemd @Chatterjee_MD

@bengnonny @DrKashyapC @NBegumOzturkMD @GroverDheera @BalissMichelle @SheharyarW @TGHermanMD @KBhowmick92 @BenClement_MD @MaryamBHaiderMD @MItaniMD @achokshi1 @jalpa_devi @menon_mythili @DarylRamai @PeterBhandariMD @seanpattyp @CamilleLupianez @DevikaGandhiMD @umer446

🗓️Stay tuned for next week's tweetorial: “Does prophylactic clipping prevent delayed bleeding after EMR of large proximal colonic polyps?” w/ @nataliejowilson

@doctornikkid ✔️ Confirm cACLD & assess CSPH ✔️ Avoid reflex INR/platelet correction ✔️ Use TEG when available ✔️ Multidisciplinary coordination ✔️ Empowering patients through open risk discussions

Procedure pearls from the guideline: ⚒️ Elective hernia repair > emergent 🫀 Cardiac surgery extremely high-risk in CTP C 🫕 Cholecystectomy OK for CTP A/B ⚖️ Sleeve gastrectomy safe in select compensated cirrhosis

7/ Paradigm Shift (INR vs TEG) Major shift: INR does NOT ❌ predict bleeding risk in cirrhosis. Routine correction? → Increases portal pressure, no benefit. Use TEG for real-time, physiologic coagulation assessment. Transfusion should be data-driven. 🩸

Before surgery: 🍽️ Improve nutrition (30–35 kcal/kg/day; 1.25–1.5 g/kg/day protein) 🚭 Stop alcohol/tobacco 💪 Address frailty/sarcopenia 🩺 Manage reversible liver injury Optimization changes survival curves.

The guideline algorithm starts with: 1️⃣ Confirming cirrhosis/cACLD 2️⃣ Determining CSPH (LSM, PLT, imaging, varices) 3️⃣ Assigning VOCAL-Penn risk CSPH = the pivotal driver of perioperative outcomes.

VOCAL-Penn > MELD/CTP for predicting postoperative mortality + 90-day decompensation. 🚨 Critical cutoff: Predicted 90-day mortality ≥15%. → Consider pre-op liver transplant evaluation. This is one of the most important updates in perioperative planning.

We’ve relied too heavily on MELD & CTP for surgical risk. Neither captures procedure intensity, frailty, or portal hypertension. 🌟The 2025 ACG Guideline gives us a structured roadmap to do better.

🚨 Three pillars define surgical risk in cirrhosis: ☑️CSPH (beyond MELD) ☑️Frailty & cardiometabolic risk (esp. MASLD) ☑️Procedure-specific stress The new guideline finally unifies all 3.

⏰ for another #EBGI Tweetorial🧵w/ @Chatterjee_MD! “Surgery in Cirrhosis: Strategies for Risk Stratification and Optimization” @doctornikkid @leandrosierraca 📜 Summary https://t.co/PQgTixKNR8 🎧 https://t.co/nLZjMUXKJs 📰 https://t.co/b9JlnowZ9q #GITwitter @AmcollegeGastro

1/ ⏰ for #EBGITweetorial🧵w/ @seanpattyp "Artificial Intelligence in Colonoscopy: Could It Be Making Us Worse?” 📜Summary: https://t.co/de01FIpKTd 📰 Article: https://t.co/dLUawZZmnV #GITwitter

1/8 ⏰ for #EBGI Tweetorial🧵w/ @guthealingg “ACG Clinical Guideline: Management of Crohn’s Disease in Adults. Am J Gastroenterol. 2025;120(6): 1225-1264]” 📜Summary: https://t.co/N6F5XoFJhy 📰 Article: https://t.co/XRSsmHAHYK #GITwitter

1/8 ⏰ for #EBGI Tweetorial🧵w/ @ceomaliko1 “[Semaglutide for the Treatment of Metabolic Dysfuction-Associated Steatohepatitis - MASH🚀]” 📜Summary: https://t.co/FUusz2kTVP 📰 https://t.co/lJIBg2tZOH #GITwitter

Day 3/4 #ACG2025: SCOPY awards! 1️⃣ @clivejmiranda and I celebrating on behalf our entire @ACG_EBGI CRC SoMe campaign team! 2️⃣ me in the presence of CRC prevention greatness, @drfolamay & @AasmaShaukatMD 🤩 3️⃣ showing some @ScrubsNHeels love w/ the glamorous visionary @IBD_Afzali

🏆 CONGRATS to our wonderful @ACG_EBGI team on yet another SCOPY Award for a successful #ColorectalCancerAwarenessMonth campaign 🍾 Well done @anoushkaduaMD @Montalvan214 @HannahWFiske @RomyChamoun 💐 @AmCollegeGastro #ACG2025

Artificial Intelligence in Colonoscopy: Could It Be Making Us Worse? Margaret J. Zhou, MD   📖 https://t.co/nPd14dUCqa @PaulYKwo @BilalMohammadMD @RomyChamoun @RahulSDalalMD @doctornikkid @SwathiEluri @nicole_rich8 @noorannemd @Chris_Velez_MD @TimYen1

In #EBGI: Semaglutide for the Treatment of Metabolic Dysfunction-Associated Steatohepatitis @PaulYKwo, MD, FACG 📖  https://t.co/ToellqDW19 @BilalMohammadMD @RomyChamoun @RahulSDalalMD @doctornikkid @SwathiEluri @nicole_rich8 @noorannemd @Chris_Velez_MD @TimYen1