Klaus Mönkemüller, MD, PhD
@KMonkemuller
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Professor, Internist, Gastroenterologist, Interventional Endoscopy, and Infectious Diseases Specialist/ Tweets are mine. Retweets are not endorsement
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Joined March 2020
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✅ The novel Stentvac (fully-covered self-expanding metal stent coated with a sponge) is ideal for bridging and closing large esophageal or esophagogastric defects.
➡️ This system is inserted over a guide-wire 👍🏻
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💊 Dabigatran-induced exfoliative esophagitis
✅ dabigatran pellets are covered with a tartaric acid core.
✅ This strong acid may result in squamous epithelial damage with ensuing exfoliative esophagitis.
➡️ endocollab
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✅ Have you seen a case of Small Bowel Pancreatitis?
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Cholangiocarcinoma
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✅ Thickened gastric folds, anemia and hypoalbuminemia
➡️ What’s the diagnosis?
➡️ Would you biopsy using forceps or go for snare resection of a fold to reach the diagnosis?
✅ EndoCollab
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✅ Have you tried the new E-VAC Stent for treating GI leaks and fistula?
✅ endocollab
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➡️ Esophagitis dissecans superficialis („sloughing esophagitis“)
✅in addition to: NSAIDs, bisphosphonates, chemical irritants, hot beverages, radiation, autoimmune bullous dermatoses or idiopathy and smoking
➡️ Also think of: dabigatran, gabapentin, celiac disease
EndoCollab
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🚨 Coin 🪙 lodged in the esophagus of a 5-year old patient.
➡️ How do you handle these cases?
✅ Tips to remove it out without damaging the esophagus on
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✅ Battery 🪫 ingestion - honey 🍯 may be a lifesaver 🙌🏻
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✅ A quick review on endoscopic band ligation for gastric antral vascular ectasias (GAVE)
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❓What is Littre's hernia?
✅Meckel's can located be as far as 167 cm from the ileocecal valve
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➡️Patchy colitis and fibrotic rings - what is the likely etiology?
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Welcome to our new ENDOSCOPY editorial board members!
Dr. Keith Siau 🇬🇧 und Dr. Katarzyna Pawlak 🇵🇱
➡️ Rising stars ⭐️ 🌟 in GI Endoscopy
@drkeithsiau
@KM_Pawlak
@ESGE_news
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➡️ Colonoscopy findings in a patient with chronic diarrhea, weight loss, malabsorption
✅ The fellow calls you in the room and you make a spot diagnosis, and confirm it when examining the patient.
➡️ What is the diagnosis?
📽️ Full video on
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✅ Congratulations 🎉 to Dr.
@JBapaye
on his first endoscopy on his first day of GI fellowship
🔝 First endoscopy done after learning:
A. Patient exam
B. Communication with anesthesia and endo staff
C. Room and space analysis
D. Ergonomics
E. Scope handling (incl. 🎥)
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🙌🏻 This is a wonderful moment, becoming permanent part of the Universidad de la República as Professor honoris causa @ the Department of Gastroenterology „Prof. Carolina Olano Gossweiler“ 🙏🏻😃
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✅ Every endoscopist should be familiar with basic Hypopharynx and Larynx anatomy
✅ Created by EndoCollab 👍🏻
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Double guidewire technique may aid in bile duct cannulation.
🧰Check out our PD-catheter and wire technique:
"As the wire is slowly advanced into the common channel, the floppy tip deflects away from the catheter facilitating cannulation of the common bile duct."
Endoscopy 2003
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➡️ Patient send to us for evaluation after “failed Zenker resection”.
➡️ The referring interventional endoscopist could not find the diverticulum.
✅ What’s the diagnosis?
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✅ Crohn’s patients with mod- to severe disease who had FAILED therapy w biologicals
✅ PLACEBO resulted in clinical remission in 30%, compared to 50% with upadacitinib
✅ 50% of patients on upadacitinib failed
✅ upadacitinib is an option, no panacea
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Congratulations to Dr. Katarzyna Pawlak
@KM_Pawlak
and Dr. Keith Siau
@drkeithsiau
for receiving the ENDOSCOPY Peer Reviewer Award 🏆👏
✅ And also for officially becoming EDITORIAL BOARD MEMBERS of the 🔝 GI Endoscopy Journal
@ESGE_news
@endoscopyjrnl
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🧰 Endoscopic resection of Zenker‘s diverticulum made simple - the rule of 3s ❗️
➡️ Three tools 🛠 and three steps (see flash card)
⚡️ These are my electrosurgical settings (3-3-3)
✅ for more ℹ️ and 🎥
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✅ Colonoscopy has low yield for detecting colon cancer in patients with diverticulitis 🤔
✅ “The risk of CRC cancer is low in most patients with diverticulitis. Patients with complicated diverticulitis are the exception.” 👉🏻
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🏆 Another big trophy at ESGE Days in Prague for Dr. Keith Siau
@drkeithsiau
👏🏻🎉
@ESGE_news
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➡️How to do the ideal India Ink Tattoo
✅ Check the short video 📽️ on Endocollab
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➡️ Basic Principles of Bile Duct Cannulation
✅ Today on EndoCollab’s ERCP Course
➡️ EndoCollab
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➡️ Both, lymphocytic esophagitis and Candida esophagitis can present with white plaques and exudates
✅ Endocollab for these board preparation slides
👍🏻 Every day a new pearl
✅ plus 10 full courses on all things GI❗️
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✅ This is the best distal transparent cap to remove foreign bodies.
✅ I am also enclosing a list of useful devices to remove ingested foreign bodies.
✅ EndoCollab
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🙌🏻 This is incredible 🙏🏻
✅ Looking forward 👍🏻 to great collaborations with the medical students, faculty and gastroenterologists from the incredible and prestigious UEES 🇪🇨 from Ecuador
@uees_ec
@uees_online
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What's the etiology of pancreatitis in this patient?
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JNET classification for colorectal polyps
✅ EndoCollab for the course: „Train your eyes to detect and character colon polyps“
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@AbelJosephMD
@brettjohnson_md
@JPAchkarMD
@amitbhattMD
@AdvaniRashmiMD
➡️Exfoliative esophagitis (esophagitis dissecans superficialis)
Etiologies and differential diagnosis:
✅medications (biphosphonates, dabigatran, sunitinib)
✅Herpes simplex Virus infection
✅ graft-versus-host disease(GVHD)
✅amyloidosis
✅pemphigus vulgaris.
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✅ Ileum intubation made easy
➡️ the 9-11 and 6 o‘clock intubation tricks
🎥 New quick tip video on
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Polyps❗️
✅There is more to 6-10 mm than a „cold snare“😮
✅ do they progress to colon cancer?
✅ Or do they REGRESS? 🫢
✅ When you use cold snare, do you tell your patients you’re doing this off-label, i. e. non-FDA approved
✅why are you sending those for pathology exam?💰
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➡️ Endoscopic signs suggestive of gastric cancer
✅ loss of vascular pattern
✅ easy bleeds
✅ convergence
✅ scar
Endocollab 👍🏻
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🔥 Breaking News 📰
🛑 Motorized (power) spiral enteroscopy was withdrawn/recalled from practice by the manufacturer (Olympus Medica) due to mechanical failures and severe adverse events (including fatality) ❗️
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👌🏻 Coconut water induces clinical remission in mild to moderate ulcerative colitis: double-blind placebo controlled trial
🌴 Anti-inflammatory and changes microbiome 🦠
➡️ Let’s not forget that lots of key „medicines“ that have improved health are 🌱
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🪱 What is your diagnosis? This patient has chronic diarrhea and B12 deficiency
📚By Dr. H. Cedrón
@hcedron
✅ Revista Peruana de Gastroenterología 🇵🇪 👍🏻
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✅ Summary of endoscopic methods for hemostasis
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➡️ Today on EndoCollab
✅ All the key steps to visually diagnose a rectal carcinoid (NET)
👍 Never miss this lesion again! 👁️
👀 The best course to train your eyes to detect and characterize colon polyps is on EndoCollab
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✅ Fish 🐠 eye 👁️ sign
➡️ very nice example of IPMN 👌🏻
➡️ why others call this „fish mouth 👄 „ sign is a puzzle to me 🤔
Papila en ojo de pez, por NPMI pancreático con ictericia por estenosis de la vía biliar, colocación de prótesis metálica
@GVAhgandia
@escapa79
@inma_miral
@alemany_gloria
@marilozahonero
@TOMASFUSTERBELL
@CarlosBoix90
@ClarsPeiro
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➡️ For those interested in advanced endoscopic resection techniques
✅ This paper is wonderful, with simple explanations!
👍 Explaining complex things in simple ways is a characteristic of the masters, like Sensei Uedo
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The dual action therapy clip with independent arms.
✅ Great concept to close large defects, grasping one side first with one clip arm, and then approximating to opposite site and grab with second arm. And close 😃
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"Based on all outbreaks of ERCP-associated infections so far, we know that poor scope cleaning practices and breaches in hygienic standards and proper drying have been the culprits...all outbreaks ceased after hygienic practices and proper drying methods were implemented."
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➡️ This is an aortoenteric fistula.
➡️ The eroding vascular stent is visible.
🛑 Never biopsy atypical appearing ulcers of the distal duodenum in patients with history of aortic grafts!
✅ EndoCollab
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➡️ Webinar de EndoCollab: Tips and Tricks for Colon Polypectomy, including Hemostasis (before and after)
➡️ Trucos y consejos para polipectomía, incluyendo hemostasis
➡️ Para toda Hispanoamérica - en español
➡️ El Sábado 17 de Diciembre
✅ El Link lo mandamos hoy
👍 Gratis💯
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➡️ Antibiotic use is associated with increased risk of colorectal polyps
✅ Dysbiosis likely leads to polyp development
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❇️ Stomach polyps in 55-year old female with ⬆️ elevated gastrin.
❇️On EGD she had several polypoid lesions. Biopsies showed carcinoid. H. pylori test was +
➡️ What type of carcinoid is this?
A. Type 1
B. Type 2 (Zollinger-Ellison)
C. Type 3
D. Adenocarcinoma
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When closing a big defect with clips, where do you start placing the first clip?
A. Edge
B. Center
C. Doesn’t matter where
✅ more on Endocollab
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🙏🏻 I am deeply honored to become part 👨🏫 of Cátedra de Gastroenterología “Prof. Carolina Olano Gossweiler”, Hospital de Clínicas, Universidad de la República, Montevideo, Uruguay 🇺🇾
@EndoCollabcom
EndoCollab
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Congratulations to Prof. Carolina Olano from Uruguay - President Elect of the World Gastroenterology Association
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❓What type of papilla is this one?
❓Does it fit into the Haraldson classification?
✅ EndoCollab
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➡️ This polyp is located in the second part of the duodenum.
• What resection technique would you use?
• What precautions would you take to prevent the polyp from going “away” into the distal bowel?
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❓When performing EGDs, have you noticed some yellow vesicles in the distal esophagus, occasionally associated with islands of cylindrical epithelium?
➡️ We characterized them using magnification, NBI, histo and electron microscopy.
✅ These are submucosal glands and metaplasia
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➡️ Patchy colitis and fibrotic rings in the cecum and/or ascending colon are characteristic of…..
✅ EndoCollab for the answer
➡️ I’ll also post it tomorrow 👍🏻
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✅ The two antibodies in autoimmune gastritis - APCA and AIFA
➡️ APCA = anti-parietal cell antibody
➡️ AIFA = anti-intrinsic factor antibody
❗️Important to know as B12-deficiency is treatable and autoimmune gastritis is a big risk factor for gastric cancer
#Helicobacter
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✅ it is possible to perform „APC” without APC using plane snare tip and electro cautery unit
✅
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✅ It’s always a dream to be with 🔝 Woman in Endoscopy 🙌🏻 Dr. Lucía Fry, pioneer in enteroscopy 🧰
@qzx92ynjvp
@ESGE_news
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🔍 Pancreas Cystic Neoplasms:
✅ Thick irregular rim
✅ Septations
✅ Solid parts
✅ Pancreatic duct >3mm, calcifications
💧 Low amylase in fluid
🔬Table: distinct traits
🚫 Sometimes, definitive diagnosis is tough
🌟 Serous cystic neoplasm: non-malignant, symptoms from size
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➡️ There is nothing more satisfying than seeing your ex-fellows ⭐️ succeed
➡️ Very nice to see now Prof. Alexander Link 💫
@alinkmd
at our Alma Mater University of Magdeburg succeeding as a leading clinician, teacher and researcher in GI, microbiome and more 🙌🏻👍🏻
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✅ New basic endoscopy video on EndoCollab 👍🏻
✅ In this video, I'll be sharing some important tips for the placement of hemostatic clips.
✅ I'll also show you how to properly advance the clip, target the lesion, adjust the rotation, and properly deploy on the bleeding lesion.
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➡️ What type of papilla is this?
➡️ It’s located on the verge of a yuxtapapillary diverticulum, just “hanging” into the lumen
➡️ Does it fit any type of Haraldson’s classification (GIE)?
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🔝 Gastroenterology Meeting 💯
✅ Colombian Congress of Gastroenterology
➡️ Up-to-date lectures and research
👌🏻 Beautiful location 🇨🇴 Cartagena de Indias 🤩
👏🏻 Did you notice that badges are recyclable? 🙌🏻
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Cronkhite Canada syndrome
✅ Once you’ve seen these slides you’ll never forget about this uncommon but important syndrome to remember 💡
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Gastric varices classification (Sarin)
✅ great review on gastric varices by Henry et al. CGH 2021
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➡️More than 1000 patients with diverticular bleeding - the CODE BLUE-J study.
➡️This study is amazing👍
📌 Diverticular bleeding 🩸
🔸 Endoscopic clipping: Direct 🎯 vs. indirect ❓
Original article:
#GITwitter
@my_ueg
@WileyHealth
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✅ gastric NET >10 mm
✅ Aim is complete resection (R0)
✅Given the fact that carcinoids "like" to create a stromal reaction in the submucosa, I have moved to more aggressive approaches such as ESD or ESD-EMR hybrid, and also eFTR
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✅ Laterally spreading tumors (LSTs) are defined as nonpolypoid lesions ≥1 cm with lateral growth.
✅ The two main categories of LST are granular (G) and non-granular (NG).
✅ LST-G have a low risk of containing cancer (approx. 10%)
LST-NG have up to 33% risk of CA
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💯 Isn’t this double pig tail stent beautiful? 👍🏻 Did you know that the first stent ever (in 1980) placed ENDOSCOPICALLY into the bile duct was a single pigtail angiographic catheter? 🧰 A case report that changed therapeutic endoscopy forever💪🏻 The legend: Prof. Nib Soehendra 🛠
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➡️Couinaud's Liver Segments
✅Couinaud named the 8 segments of the liver from
the center (segment 1) clockwise when a cast of the liver
vessels is seen from above, allegedly reproducing the
distribution of the districts (arrondissements) of Paris.
Ref: Majno, J Hepatol 2014
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✅ Candida esophagitis, Kodsi classification, grade 2
✅ EndoCollab
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➡️ Endoscopic hemostasis in one photo
✅ EndoCollab for more, including 🔝 teaching videos.
🙌🏻 And tips and tricks even your attendings don’t know 😁
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✅ With my 🔝 ENDOSCOPY TEAM at the Christmas 🎄 Dinner 🇩🇪
🔝 Six nurses, one secretary and three GI endoscopists 🙌🏻
➡️ I’m the only man 😁
#WomaninGI
#GITwitter
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➡️ H. pylori has a “sting-like” complex to inject the cell (type IV secretion system)
➡️ Like a mosquito 🦟, it penetrates into a cell to deliver DNA 🧬 contents, including CagA
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✅ New on - Quick Video Tips in GI Endoscopy.
➡️ Today „Cap-assisted through-the-scope Clip for GI bleeding“
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✅ This is smart !
✅ Vacuum therapy for esophageal perforations through the stomach
👍🏻 Life saving intervention that can be done anywhere in the 🗺️
📦 Thinking outside the box 👍🏻
"Transgastric drainage of the perforated esophagus: our experiences over 10 years"
#EsophagealPerforation
#BoerhaaveSyndrome
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This month there will be a new course in dedicated to Small Bowel Diseases, including Atlas of Ulcerative Diseases, therapeutic enteroscopy, Direct Percutanous Endoscopic Jejunostomy, small bowel bleeding, tips and tricks for small bowel resection, etc
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➡️ Menètriérs Disease - always important to communicate with the pathologist to secure the diagnosis
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👍🏻 Group picture 📷 of the Department of Gastroenterology „Prof. Carolina Olano Gossweiler“, Hospital Universitario, Montevideo 🇺🇾
➡️ Notice how Uruguay lives and believes on the concept of „Woman in Gastroenterology“? 🙌🏻 🇺🇾💯
➡️ 75% of faculty members are female 👍🏻
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✅ Classification of GAVE
👌🏻 EndoCollab
Gastric Antral Vascular Ectasia (GAVE)
-Associated w/: portal hypertension, chronic renal failure, bone marrow transplant, hyperthyroidism, collagen vasucular diseases
-Endoscopic therapy: argon plasma coagulation, endoscopic band ligation and RFA
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➡️ Olmesartan-induced enteropathy
✅ From the course: Small Bowel Diseases in
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✅Live from AEM London
🎥Tomorrow lecture about hemostatic powders
✅ 3rd generation powder-gel ❗️
✅Hydrophilic, biocompatible adhesive material made of two polymers: dextran and succinic acid modified L-Lysine
➡️Forms adhesive gel after contacting 🩸 by reversible crosslinking
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✅ it’s time to restart utilizing re-usable biopsy forceps, sphincterotomes, wires, Savary dilators, etc
✅ There is great evidence in the safety of doing above ⬆️
➡️ Paradoxically, every endoscopy unit is moving into using only disposable accessories 🤔🫢
A critically-needed new area in GI and
#endoscopy
!!
Dr. Heiko Pohl reviews tips for improving GI practice for
#climate
sustainability in the 21st century
We all can do better 🙌
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🥇 I won a gold medal today 🙌🏻 💯
✅ Look who my Twitter twin is 🔝🏆
✅ Who is your Twitter twin? 👯
@KMonkemuller
=
@drkeithsiau
KMonkemuller and drkeithsiau are Twitter twins!
@EndoCollabcom
#twitterTwin
#toasteed
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