89M p/w jaundice h/o distal gastrectomy with RY, now with large pancreatoduodenal recurrent mass causing distal CBD obstruction. ✅Enteroscopy via RY limb showed large duodenal mass- failed ERCP ✅EUS-guided antegrade biliary stenting via left hepatogastrostomy access 1/2

Thanks Tried multiple 0.018, 0.025, 0.035 straight & angled wires incl stiff wire w/o success. Stiff straight tip would go through side holes after too much pressure w/o going into upstream duct. Tried Sohendra stent retriever w/o luck. 6Fr cystotome & laser not available

Complete uSEMS occlusion (tumor ingrowth)- unable to pass any wire/catheter Options other than EUS-BD? @MISIRG1 @EndoTx @ChahalPrabhleen @docdhir @NEndoscopy @DouglasAdlerMD @Taalamri @helpatologist @GIscope_updates @jeanvemer @SunilAminMD @DrLakhtakia @japariciot2 @amolbapaye

ESD for large 6.5x5.5 cm friable bulky rectal mass Tips to retrieve❓ @MISIRG1 @RobertBechara @SunilAminMD @EndoscopyOthman @BilalMohammadMD @drKumarGI @MoamenGabrMD @ENDOS96 @DrSaeeeed @amolbapaye @drsridhars @SultanMahmoodMD @NorikoSuzuki3 @shaimaa_elkholy @ASCRS_1 @GI_Guy

@DrLakhtakia @japariciot2 @NEndoscopy @jeanvemer @SahajRathi @ShimaghavimiMD @allie_schulman @AustinChiangMD @SunilAminMD @DavidDiehlMD @AhmadBazarbashi @GI_Pearls @RashidLui @PopovVioleta @TrieuMD @EndoTx @DrAnuraagJ @JagpalKlair @CelestinoGutirr @DrBloodandGuts @KMonkemuller @drdeepakmadhu @EHolzwanger @doctorboletoh @mj_pucci @MdAntonieta 3/3 ✅EUS scope passed through EUS-GJ to access jejunum distal to high-grade jejunal obstruction c freehand EUS-JJ @AmCollSurgeons @tberzin @AgnihotriGI @SyedGerdezi @shailsingh @SighPichamol @amolbapaye @stevenbollipo @Srisha_Hebbar @docdhir @SultanMahmoodMD @sminaev2015 @IHPBA

2/3 ✅Freehand EUS-GJ c 20mm LAMS➡️dilated to 18mm➡️anchored c TTS clips @DrLakhtakia @japariciot2 @NEndoscopy @jeanvemer @SahajRathi @ShimaghavimiMD @allie_schulman @AustinChiangMD @SunilAminMD @DavidDiehlMD @AhmadBazarbashi @GI_Pearls @RashidLui @PopovVioleta @TrieuMD @EndoTx

EUS-GUIDED JEJUNOJEJUNOSTOMY via EUS-GUIDED GASTROJEJUNOSTOMY 1/3 (single-session DUAL BYPASS using LAMS for malignant gastric and jejunal obstructions) @SAGES_Updates @MISIRG1 @ChahalPrabhleen @KM_Pawlak @DharJahnvi @Taalamri @drkeithsiau @BilalMohammadMD @helpatologist @my_ueg

COLONIC VARIX with a NIPPLE SIGN p/w massive lower GI bleeding c hemorrhagic shock ▶️TIPS+coil embolization @my_ueg @stevenbollipo @KM_Pawlak @KMonkemuller @almagoch @MdAntonieta @RashidLui @jeanvemer @DharJahnvi @DrHarryThomas @drdalbir @Samir_Grover @GI_Pearls @drkeithsiau

Congratulations @Davy_NT for seeing this project through. Enhanced suction works really well for small to medium sized food impactions. Credit to @TarunRustaGI_MD @ZSobaniMD @swathipaleti for the first description of this technique for blood clots @PittGILiverNutr @BIDMC_GI

I do (almost) all EDGE as Single-session but hasn't had a more urgent indication than Acute Cholangitis on low-dose Levophed! @my_ueg @MISIRG1 @KM_Pawlak @drkeithsiau @helpatologist @ChahalPrabhleen @japariciot2 @teoh_anthony @DharJahnvi @IHPBA @Taalamri @EAHPBA @SAGES_Updates

Here's another NIPPLE SIGN in variceal bleeding (probably the largest I've seen) @AmCollegeGastro @drkeithsiau @DouglasAdlerMD @AdvaniRashmiMD @RashidLui @stevenbollipo @Samir_Grover @almagoch @Taalamri @my_ueg @ShimaghavimiMD @DrBloodandGuts @BilalMohammadMD @ASGEendoscopy

And then a complementary video-based session Monday at 4p-'Safety Not Guaranteed: Unforeseen Events During Interventional EUS (Video Session)'. Another all-star crew -- Arain, Chen, Chahal, & Law - taking us through cases when they don't go according to plan w/ expert moderators.

Our multicenter comparative study EUS GJ+BD vs Surgical GJ+HJ online @GIE_Journal ✅ 5 acad 🏥 ✅ similar TS, CS rates ✅ 🔽ADE (11.3% vs 34.7%) ✅ 🔽median TOI n 🔽 hosp stay 🤝👍😇 @MBronswijkMD @GVanell5 @Jayanta_sam @MarcBesselink @PepiDellAnna

Randomly found🎥 Radioactive scrolling @netflix Couldn't be a more befitting day to watch such a movie #IWD2023 @womensday However, post-movie @Wikipedia search was shocking: <5% of Science @NobelPrize have been awarded to women. Hopefully, this will get better in future!!

#Halloween #EUS #PancreaticCancer- malignant transformation of mucinous cyst? @ChahalPrabhleen @KM_Pawlak @AdvaniRashmiMD @BilalMohammadMD @japariciot2 @drkeithsiau @ShimaghavimiMD @SunilAminMD @DouglasAdlerMD @DeMadaria @jeanvemer @GI_Pearls @RashidLui @drdalbir @AustinChiangMD

#MakingItEasy EUS-GBS for small GB Acute on chronic cholecystitis▶️ Distending GB with 19G FNI before free-hand CE-LAMS (similar to EDGE) @my_ueg @japariciot2 @ChahalPrabhleen @KM_Pawlak @ShimaghavimiMD @sminaev2015 @CelestinoGutirr @SyedGerdezi @RodriguezParra_ @drkeithsiau

Rare to catch faculty mentors from 2 alma maters in one frame! - at NASCAR hall of fame @bret_petersen @MayoClinicGIHep @HarryAslanian @YaleDigestive #ACG2022 @AmCollegeGastro

Amazing EUS course organized by #bostonsci. @TarunRustaGI_MD and his two golden LAMS deployment rules were the highlight of the day.

A masterly talk with some brilliant practical tips on EUSBD by 🌟@TarunRustaGI_MD #stokeERCPEUS22 @Srisha_Hebbar @drnataliegastro @GWebster_endo @NEndoscopy @drkeithsiau @SyedGerdezi @rizsaleem @prmphotog Snippets 👇

@TarunRustaGI_MD spreading his pearls of wisdom on EUS guided biliary drainage. #StokeEUSERCP.

EUS guided biliary drainage techniques - fantastic overview from the legendary @TarunRustaGI_MD #GITwitter #StokeERCPEUS22