Dalbir Sandhu, MD, FACG, FASGE
@drdalbir
Director of Endoscopy @dignityhealthaz Trained @mayoclinic @uiowa @cookctyhealth Tweets = opinion, RTs/Likes≠endorsement
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15-06-2009 22:04:10
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For those performing EUS-GJ: if you can’t pass a guidewire into the duodenum/jejunum due to complete gastric outlet obstruction from an ulcerated mass, do you refer for surgical GJ — or have another trick up your sleeve? Douglas G. Adler MD, FASGE, FACG, AGAF Neil Sharma, M.D. FASGE, FACG, AGAF Sundeep Lakhtakia Sunil Amin, MD, FASGE, FRCPC
Dalbir Sandhu, MD, FACG, FASGE Douglas G. Adler MD, FASGE, FACG, AGAF Neil Sharma, M.D. FASGE, FACG, AGAF Sundeep Lakhtakia Usually, yes. If I am feeling ambitious I look to see if there is a dilated-ish loop distal to the obstruction that I can freehand puncture with a 19 gauge needle and fill in hopes of creating an acceptable window for LAMS. Some have also described direct peritonoscopy approach!
Dalbir Sandhu, MD, FACG, FASGE Douglas G. Adler MD, FASGE, FACG, AGAF Neil Sharma, M.D. FASGE, FACG, AGAF Sundeep Lakhtakia Sunil Amin, MD, FASGE, FRCPC We published this scenario for this thing. But I reserve this for pts who are non surgical candidates in clinical practice thieme-connect.com/products/ejour…
Dalbir Sandhu, MD, FACG, FASGE Douglas G. Adler MD, FASGE, FACG, AGAF Neil Sharma, M.D. FASGE, FACG, AGAF Sundeep Lakhtakia Sunil Amin, MD, FASGE, FRCPC NOTES is an option.. sometimes downsizing to XP scope helps too
Dalbir Sandhu, MD, FACG, FASGE Douglas G. Adler MD, FASGE, FACG, AGAF Neil Sharma, M.D. FASGE, FACG, AGAF Sundeep Lakhtakia Sunil Amin, MD, FASGE, FRCPC Try an angled or straight glide wire first, it will usually help you get through. Searching for a loop on eus for direct stick is ambitious and honestly you don't know what you are going to get. Always better to bail and either try again or call surgery
Dalbir Sandhu, MD, FACG, FASGE Douglas G. Adler MD, FASGE, FACG, AGAF Neil Sharma, M.D. FASGE, FACG, AGAF Sundeep Lakhtakia Sunil Amin, MD, FASGE, FRCPC How about that? 👇 e-ce.org/journal/view.p…
Dalbir Sandhu, MD, FACG, FASGE Douglas G. Adler MD, FASGE, FACG, AGAF Neil Sharma, M.D. FASGE, FACG, AGAF Sundeep Lakhtakia Sunil Amin, MD, FASGE, FRCPC Judy Trieu, MD, MPH & Todd H Baron MD, MASGE published this technique for this particular situation! pmc.ncbi.nlm.nih.gov/articles/PMC10…
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#FTRD cont to be a 🛠️ for mgmt of difficult lesions 1st report of a Novel #FullThicknessResection Device for ✂️ early #CRC 🔥now Endoscopy Journal ✅ Ease of use Need data to compare efficacy to existing #FTR devices 👏 to Tessa Herman for leading this thieme-connect.com/products/ejour…
Judy Trieu, MD, MPH Tom Tielleman, MD Dalbir Sandhu, MD, FACG, FASGE Douglas G. Adler MD, FASGE, FACG, AGAF Sundeep Lakhtakia Sunil Amin, MD, FASGE, FRCPC Todd H Baron MD, MASGE Tough cases ! Dalbir Sandhu, MD, FACG, FASGE thank you for asking this question.. the solution from my UNC Gastroenterology family tree is a good option. Complexity is keeping the jejunum distended as doing rapid exchange. Patient positioning helps sometimes. Also direct endoscopic”flooding” from lumen
