J. Sebastián P. A.
@JSebastianPA
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🇨🇴 Just sayin'. MD, UNAB. Internal Medicine, UdeA. Gastroenterology, U-CES Special interest in Interventional Endoscopy 📺Gastrobacter (Youtube)
Medellín, Colombia
Joined July 2017
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Si un fármaco post-IAM redujera la mortalidad total en 41% sería portada en todos los congresos de cardiología y sería REGLA GENERAL en todos los hospitales. Pero lamentablemente sigue muy olvidada. Hilo 🧵 del estudio de la vacuna contra influenza en post IAM 👇👇.
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Grateful for the opportunity to attend the Annual @WashUMedGastro Advanced Endoscopy Course & Hands-on sessions. Fantastic learning experience with colleagues and outstanding faculty.@VMKGIMD @AhmadBazarbashi @TrieuMD .@mswaghden @ChahalPrabhleen @shailsingh @Samuel__Han
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DDx of gastrointestinal hamartomatous polyposis.Peutz-Jeghers syndrome .Juvenile polyposis syndrome .Cowden syndrome.Cronkhite-Canada syndrome.
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RT @froilanbustaman: “Mis propios hijos me dejaron en un asilo… y se llevaron todo. Así que decidí empezar de nuevo. Pero esta vez, sin ell….
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RT @LumirKunovsky: 📢🔥Olomouc Live Endoscopy🔥.2️⃣0️⃣2️⃣5️⃣. ✅️ Join us "ONLINE" for free for the Latest in Third Space #Endoscopy❗️. 💥 @Thir….
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Diagnostic algorithm for suspected eCCA. ERCP + brush cytology & endobiliary forceps biopsy is suggested as the 1ry tool. Overall sensitivity of brush is: 43%.Combined with forceps: 66%. 👉Cholangioscopy-directed biopsies is suggested when: i) previous ERCP sampling was negative
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Transoral Outlet Reduction (TORe): Indications and Contraindications
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Type I: duodenal wall injury from scope angulation or forceful withdrawal during stone extraction.Type II: perforation from large balloon sphincteroplasty or deep sphincterotomy.Type III: bile duct injury from wire/basket, seen after contrast injection. Stapfer M, Ann Surg 2000
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3⃣Aspirate a small amount of bile before injecting contrast: This ensures the removal of any residual air within the system. 4⃣Inject contrast slowly and steadily: A controlled injection minimizes the formation of air bubbles.
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💡How to Avoid Bubbles During Cholangiography.1⃣Use 10–20 mL syringes: This reduces the need for frequent exchanges and minimizes the risk of introducing air bubbles. 2⃣Preflush the catheter with contrast before cannulation.
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🫵Please use: snare-tip soft coagulation (ERBE VIO SOFT COAG: 80W, Effect 4; ERBE, Tübingen, Germany). 🚨A four fold reduction in adenoma recurrence at first surveillance colonoscopy
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✍️Applying thermal ablation to the post-EMR defect margin (EMR-T) plays a key role in lowering recurrence risk. Dr. Michael Bourke et al., in @AGA_Gastro, showed that EMR-T is simple, low-cost, and highly effective (1.4% recurrence👌). Gastroenterology 2021;161:163–170
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🚨Residual or recurrent adenoma after EMR is a ecognized limitation with a frequency at first surveillance generally reported at 15%–20%.💀. 💡It represents a potential contributing factor to interval colorectal cancer
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Two penetrated vessels on gastric cardia. 1, Oblique muscle 2, circular muscle 3, 1st penetrated vessel; 4, 2nd penetrated vessel (c) Final position by double scope endoscopy. 💡TPVs appears to be a simple and reliable indicator to determine the appropriate distal end of myotomy.
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Several landmarks are currently used to identify the correct localization of the cardia during POEM. transillumination POEM auxiliary technique with a second ultra-slim gastro scope inserted transnasally, advanced into the stomach and retroflexed. by Francisco Baldaque-Silva
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💡Important luminal landmarks in POEM. a=spine.b=aortic arch.c=trachea.d=left main bronchus.e=GEJ in retroflexion .f=GEJ in forward view. 📗@NatRevGastroHep.@RobertBechara
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💡Preoperative biliary drainage in Pancreatic Cancer. 🟨bilirubin level is >14mg/dL.💉jaundice pts planned to receive neoadjuvant treatment.🔪surgery will be delayed for longer than 2 weeks.🦠cholangitis.
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