Andy Tau, MD
@DrBloodandGuts
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Gastroenterology Hospitalist @AustinGastro . Trained @BCMhouston , @Harvard
Austin, TX
Joined October 2020
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Sometimes you think it’s just another bleeding ulcer and the world surprises you with this bleeding hyperplastic polyp doing a little jig.
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Let’s talk tips and tricks of band ligation and OTSCs, which both utilize cap and suction.
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Big clots are still a big problem in modern endoscopy. Here is a method to turn a flexible/rigidizing overtube into a large suction attachment to evacuate clots rapidly from the stomach.
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PEG tube tip:
When there is no red light trans-illumination, you must abort. If I only relied on finger indentation, I would have skewered the sliding liver edge. Rare does IR fine a way if you cannot. Sometimes surgical G tubes are the only safe way.
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Did you know not all PPIs are equally potent, and 20mg bid is better than 40 qd?
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A patient develops pain when bolus feeding their PEG tube (20d old). You suspect buried bumper syndrome, but how do you proceed if the bumper out of the stomach?
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Just got my hands on this NEW fully rotatable sphincterotome! The rotation is silky smooth & adds the final degree of freedom missing in tip control so badly needed in: intra-dochal (hilar, cystic), altered anatomy ERCP and papilla in duodenal diverticulum!
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The combination of Erosive Esophagitis and varices is a bad one. Here is is a case of Grade C Esophagitis and EV resulting in an obvious high risk stigmata.
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Ischemic gastritis from suspected thromboembolism with multifocal bleeding/oozing. Hemospray utilized.
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Did you know these hemorrhoids are actually external hemorrhoids even though they are seen “internally”? They are below the dentate line. Don’t band on them! Go 2-3 cm proximal/upward.
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As my son will remind you, it’s smoother and less traumatic to perform generous sphincterotomy and balloon sphincteroplasty upfront when dealing with a big stone.
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Pt presented with RUQ pain and fever. What is happening? What is the next step?
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If you have ever struggled with clearing blood clots in the stomach, you need to come to this session!
I have helped inspire and develop a device that can covert a flexible overtube into a suction hose!
Come check it out!
#GITwitter
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Guess the pathology?
80 F with Afib with acute abdominal pain and syncope.
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The concern for thermal injury causing perforation is a real one. A delayed duodenal perforation is quite morbid. Examine the bed of the ulcer as well as you would an advanced adenoma.
Is there a perf here ?
If so OTSC is the one and only answer.
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Everyone calm down. We finally found the right stent.
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Let’s talk tricks for augmenting suction during endoscopy, as big clots/food in the proximal stomach is still a modern day problem. Let this principle guide us:
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Perforated duodenal ulcer w/ visible vessel in a patient with subarachnoid hemorrhage (Cushing’s ulcer). What would you do next?
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Severe ischemic colitis at rectosigmoid. Even looking this bad , the patient pulled through without surgery.
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Severe Herpes Esophagitis in a patient in prolonged high dose corticosteroids for glomerulonephritis. Worst esophagitis I have ever seen.
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Migrated rectal SEMS, impacting the dentate, causing severe pain. Ingrowth at proximal end.
Lattice cut with OVESCO Remove System
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For topical hemostasis in arterial bleeds, the rate of bleed must be overwhelmed by the rate of powder delivery, so that the ratio of powder:blood rapidly climbs. Stay on it. If the blood overwhelms the powder (spurt through seen here), you’re back at square one.
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Suction Cap Assisted food bolus extraction method. I tried this after the Scoping Sunday didactic last month.
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has changed my practice
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