Podcasts about ercp

ERCP in liver transplantation can be challenging — from indication to execution. Jeanin van Hooft explains it all!

In this episode of The Interventional Endoscopist, I sit down with Dr. Jessica Widmer—Division Chief of Gastroenterology at NYU Langone Hospital–Long Island—for an honest, insightful, and inspiring conversation. Dr. Widmer shares her journey from a small town in Pennsylvania to becoming a leader in interventional endoscopy. We discuss her training path, early exposure to ERCP and cholangioscopy, and her decision to pursue advanced training at Cornell. She reflects on mentors who shaped her career, including Dr. Stavros Stavropoulos and Dr. Michel Kahaleh, and offers practical tips on teaching and performing cholangioscopy and pancreatoscopy. The episode also touches on the evolution and future of GI, training Challenges women face in interventional endoscopy, and balancing demanding careers with family life. We discuss the value of mentorship and society involvement Whether you're an advanced fellow, practicing endoscopist, or simply curious about the human side of medicine, this conversation delivers wisdom, humor, and heart. Subscribe, rate, and share—and stay tuned for more episodes exploring the minds shaping the future of GI.   Link to the GOLD program: https://www.asge.org/home/education/advanced-education-training/leadership-development/gi-organizational-leadership-development-program

Na žlučové cesty, třeba při jejich ucpání či zúžení, je tu zajímavá metoda ERCP. Do jícnu a žaludku, například kvůli refluxní chorobě, se endoskopista zase podívá metodou gastroskopie. Plejáda endoskopických metod i technik a postupů se ovšem průběžně velmi podstatně rozrůstá.

Wie beeinflussen die neuen Abrechnungssysteme den Klinikalltag? Im Nachgang unseres DGVS DRG Forums vor einer Woche diskutieren Jörg Albert, Thomas Rösch und Petra Lynen am Beispiel von ERCP und Resektionen, welche Herausforderungen und Unsicherheiten die Umstellung mit sich bringt. Während die Ambulantisierung im Rahmen der aktuellen Abrechnungsvorgaben hauptsächlich durch wirtschaftliche Zwänge bestimmt wird, bleiben Entbürokratisierung und Qualitätssicherung auf der Strecke. Ein kritischer Blick auf die Realität hinter den Reformen.

In this episode, hosts Drs. Temara Hajjat and Jenn Lee talk to Dr. David Vitale about EUS and ERCP indications in patients with acute pancreatitis and pancreatitis complications. Dr. Vitale is a pediatric gastroenterologist, the director of the interventional endoscopy center at Cincinnati Children's Hospital and Medical Center, and an Assistant Professor at the University of Cincinnati School of Medicine.  Learning Objectives:Understanding the indications of ERCP and EUS in acute pancreatitis Understand the indications of ERCP and EUS in pancreatitis complications Recognize the possible risks of EUS and ECRP in childrenSupport the showThis episode may be eligible for CME credit! Once you have listened to the episode, click this link to claim your credit. Credit is available to NASPGHAN members (if you are not a member, you should probably sign up). And thank you to the NASPGHAN Professional Education Committee for their review!As always, the discussion, views, and recommendations in this podcast are the sole responsibility of the hosts and guests and are subject to change over time with advances in the field.Check out our merch website!Follow us on Bluesky, Twitter, Facebook and Instagram for all the latest news and upcoming episodes.Click here to support the show.

Welcome back to Scrubbing In! this episode, hosts Alan, and Mo are joined by Hemel Modi, currently an HPB Fellow at Cambridge, to dive deep into the complexities of pancreatic cancer. We explore everything from clinical scenarios to surgical techniques, exam strategies, and multidisciplinary approaches. This episode is packed with actionable insights, including the key steps for managing pancreatic cancer cases in the FRCS General Surgery exam, complications to watch for post-operatively, and the latest advancements in surgical oncology. We're also proud to announce that this episode is sponsored by Johnson & Johnson, who continue to support surgical education and training through innovative resources and fellowships. Key Takeaways: • Comprehensive FRCS exam preparation tips for pancreatic cancer. • Discussion on Whipple's procedure and its nuances, including pylorus-preserving techniques. • Diagnostic and imaging strategies: CT, EUS, ERCP, and more. • Multidisciplinary care in HPB surgery. • Common exam pitfalls and how to avoid them.

In this episode, Martin talks to Cansu Cimen, a researcher at University Hospitals Groningen in the Netherlands, about a recent paper that documents an outbreak and in particular the critical role of next-generation sequencing (NGS) in tracking and controlling the transmission of MDROs via contaminated duodenoscopes. Focusing on an outbreak linked to ESBL-producing Citrobacter freundii and Klebsiella pneumoniae after endoscopic retrograde cholangiopancreatography (ERCP), standard culture methods failed to detect contamination. After many negative cultures using established methods, destructive dismantling of the implicated scope revealed contamination on hard-to-clean components, highlighting NGS as an effective tool for identifying pathogen transmission pathways. Cimen C, Bathoorn E, Loeve AJ, Fliss M, Berends MS, Nagengast WB, et al. Uncovering the spread of drug-resistant bacteria through next-generation sequencing based surveillance: transmission of extended-spectrum beta-lactamase-producing Enterobacterales by a contaminated duodenoscope. Antimicrob Resist Infect Control 2024;13(1):31. https://doi.org/10.1186/s13756-024-01386-5. Download the paper here

In this episode, Martin talks to Cansu Cimen, a researcher at University Hospitals Groningen in the Netherlands, about a recent paper that documents an outbreak and in particular the critical role of next-generation sequencing (NGS) in tracking and controlling the transmission of MDROs via contaminated duodenoscopes. Focusing on an outbreak linked to ESBL-producing Citrobacter freundii and Klebsiella pneumoniae after endoscopic retrograde cholangiopancreatography (ERCP), standard culture methods failed to detect contamination. After many negative cultures using established methods, destructive dismantling of the implicated scope revealed contamination on hard-to-clean components, highlighting NGS as an effective tool for identifying pathogen transmission pathways. Cimen C, Bathoorn E, Loeve AJ, Fliss M, Berends MS, Nagengast WB, et al. Uncovering the spread of drug-resistant bacteria through next-generation sequencing based surveillance: transmission of extended-spectrum beta-lactamase-producing Enterobacterales by a contaminated duodenoscope. Antimicrob Resist Infect Control 2024;13(1):31. https://doi.org/10.1186/s13756-024-01386-5. Download the paper here

Broadcast from KSQD, Santa Cruz on 10-10-2024: Dr. Dawn announces Medicare's new list of over 200 drugs available for $2 per 30-day supply, covering a wide range of medications. She discusses a new urine test called ExoDx for prostate cancer screening, which can help avoid unnecessary biopsies in the "gray zone" of elevated PSA levels. The doctor addresses a listener's question about Klebsiella pneumoniae found in a nasal swab, explaining colonization versus infection and the risks of unnecessary antibiotic use. Dr. Dawn explores the reliability of QuantiFERON TB tests, suggesting potential false positives and the importance of retesting with different antigen tubes. She discusses orthostatic hypotension in older adults, offering practical tips like squeezing a firm ball before standing up and proper standing techniques to prevent falls. The doctor explains the importance of vitamin A for vegans, highlighting potential BCMO1 genetic variations that may affect beta-carotene conversion and recommending blood tests. Dr. Dawn addresses a question about elevated bilirubin levels post-gallbladder removal, discussing possible causes and diagnostic procedures like MRI and ERCP.

Das Thema Krankenhausreform beschäftigt uns seit geraumer Zeit. In NRW wurden die Leistungsgruppen eingeführt, vor allem mit dem Ziel komplexe Eingriffe mehr und mehr zu zentralisieren und so die Qualität der Versorgung zu verbessern. Die Gastroenterologie ist davon bisher nicht betroffen, man könnte jetzt sagen, das ist gut so. Andererseits bedeutet es, dass unsere komplexen Leistungen, wie zum Beispiel die ERCP, um die es heute gehen wird, unter dem Radar laufen und vielleicht sogar drohen, in die allgemeine Innere Medizin abzudriften. Was aber würde dies für die Versorgungsqualität bedeuten? Petra Lynen plaudert heute mit Ludger Leifeld, Chefarzt am St. Bernward Krankenhaus in Hildesheim und Leiter DGVS Kommission Qualität über die Publikation „Einfluss der Spezialisierung auf die Erfolgs- und Komplikationsrate bei der ERCP“ und darüber, wie wichtig eine Zuordnung dieser komplexen Leistung zu unserem Fachgebiet ist.

In this EE epsiode we discuss with Amrita Sethi from New York again - we discuss recent randomized studies how to drain the bile duct in distal malignant obstruction: Via ERCP or via EUS access to place a metal stent

Last time with Nageshwar Reddy we saw exciting tips and tricks if ERCP cannulation becomes difficult. Now we can relax with his brilliant course of normal sphincterotomy

Master Nageshwar Reddy continues with his basic ERCP series and the hot topic of difficult cannulation

This is the start of an ERCP series with Master Nageshwar Reddy - the first episode is about how to position the papilla and how to cannulate

Dr. Komanduri shares how he performs a successful ERCP, explains how patient anatomy dictates planning and explores why the double-wire technique – using Autotome™ Pro RX Cannulating Sphincterotome – is his preferred approach to biliary access. 

Citrón a Fentanyl so šťastím nezabil. Keď si voláte sanitku, nechajte vchodové dvere otvorené. Zlé výsledky zvyknú byť vyznačené hrubým písmom. Podvedome pacientom prajeme lepšiu diagnózu. Keď aj doktori (Jožko+Lukáš) rozmýšľajú, čo je vlastne ERCP. Krv ako kola. NEXT? HIŠA FRANKO, GRIČ A CRNO ZRNO/slovinský bedeker  https://open.spotify.com/episode/1nij2IxxC0qoz5t1n1XSFm?si=BSfLyToQTuScOk9KFkGDIQ  Tento týždeň vám podcasty ZAPO prináša SPP, s elektrinou a plynom jednoducho a výhodne pod jednou strechou  https://moje.spp.sk/  Penta zlepšuje zdravotníctvo: Nová nemocnica Bory  https://nemocnica-bory.sk/   S VÚB účtom, appkou a kartou od Visa si deti poradia aj s peniazmi  https://www.vub.sk/ludia/ucty/juniorbanking.html  Vražedné Psyché LIVE po prvýkrát v ČESKEJ REPUBLIKE! 14. apríla o 18:30 / KD Rubín, Brno. A hneď o 2 dni, 16. apríla Trenčín, Piano Club. V Trenčíne sa vám predstaví aj podcast Zveromachri, hrať bude kapela Silky Džon a pán doktor Droba otvorí večer hrou na klavíri. Vstupenky na  www.zapotour.sk  Podcasty by ZAPO môžeš počúvať už aj na Youtube a nezabudni nám dať odber  https://www.youtube.com/@ZAPOTV  Produkcia @doktormafilipaofficial by ZAPO @zapoofficial   

Im Nachgang zu den letzten DGVS-Rundmails fasst Jörg Albert für uns die neuesten Entwicklungen zusammen, ERCP and endosonographische Punktionen werden zu Hybrid-DRGs; zudem diskutieren wir endoluminale Eingriffe wie größere Endoresektionen.

Host: Peter Buch, MD, FACG, AGAF, FACP Guest: Prabhleen Chahal, MD Post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis is the most dreaded complication of this procedure. So what are the patient-related, procedure-related, and operator-related risk factors for developing post-ERCP pancreatitis, and how can we work to prevent it? Join Dr. Peter Buch as he speaks with Dr. Prabhleen Chahal, Program Director of the Advanced Endoscopy Fellowship at the Cleveland Clinic.

Dr. Maranki explores advances in ERCP technology and technique, approaches to cannulation and access, treatments for stones and strictures – and the impact of mentors and allies on her career. ENDO-1715504-AA

How Does Milk Thistle Work for Gallbladder Health? Benefits of Milk Thistle for Gallbladder Health Milk thistle has been shown to be effective in: Reducing symptoms of gallbladder problems, such as pain, nausea, and vomiting Preventing gallstones from forming Improving liver function Promoting overall bile duct health What is the gallbladder? The gallbladder is a pear-shaped organ located in the upper abdomen, just beneath the liver. It stores and concentrates bile, a fluid produced by the liver that helps break down fats in the small intestine. What are the functions of the gallbladder? The gallbladder's primary function is to store and concentrate bile. When you eat a fatty meal, your gallbladder contracts and squeezes bile into the small intestine, where it helps to emulsify fats so that they can be absorbed by the body. What are gallstones? Gallstones are hard deposits that can form in the gallbladder. They are typically made up of cholesterol, bile pigments, and proteins. Gallstones can cause pain and inflammation of the gallbladder, and they can also block the flow of bile, leading to jaundice and other complications. What are the symptoms of gallbladder problems? Common symptoms of gallbladder problems include: Abdominal pain, especially in the upper right quadrant Nausea and vomiting Fever and chills Jaundice (yellowing of the skin and eyes) Light or clay-colored stools Dark urine What are the risk factors for gallbladder problems? Risk factors for gallbladder problems include: Being female Being overweight or obese Having a family history of gallstones Having diabetes Eating a high-fat diet Having low levels of "good" cholesterol (HDL) How are gallbladder problems diagnosed? Gallbladder problems are typically diagnosed with ultrasound or CT scans. In some cases, an ERCP (endoscopic retrograde cholangiopancreatography) may be necessary to diagnose or treat gallbladder problems. How are gallbladder problems treated? Treatment for gallbladder problems depends on the severity of the condition. In some cases, dietary changes or medication may be sufficient to relieve symptoms. In more severe cases, surgery to remove the gallbladder (cholecystectomy) may be necessary. How can you prevent gallbladder problems? There are a number of things you can do to reduce your risk of developing gallbladder problems, including: Maintaining a healthy weight Eating a low-fat diet Getting regular exercise Controlling your blood sugar if you have diabetes Additional Information The gallbladder is not essential for life. People who have had their gallbladder removed can still live healthy lives. There are a number of natural remedies that may help to relieve symptoms of gallbladder problems, such as apple cider vinegar, turmeric, and milk thistle. It is important to see a doctor if you are experiencing any symptoms of gallbladder problems. Apple Cider Vinegar Apple cider vinegar is a type of vinegar made from fermented apples. It contains acetic acid, which has antibacterial and anti-inflammatory properties. Some studies suggest that apple cider vinegar may help to improve bile production and flow, which can help to prevent gallstones. Additionally, apple cider vinegar may help to reduce inflammation in the gallbladder. Turmeric Turmeric is a spice that has been used in traditional Indian medicine for centuries. It contains curcumin, a compound that has powerful anti-inflammatory and antioxidant effects. Studies have shown that turmeric can help to reduce inflammation in the liver and gallbladder, and it may also help to prevent gallstones from forming. #gallbladderhealth,#gallbladders,#gallstones,#cholecystitis,#biliaryduct,#liverhealth,#pancreatichealth,#digestivesystem,#wellness,#healthyliving,#milkthistle,#silymarin,#naturalremedies,#herbalmedicine,#gallstones,#bileducts,#digestivehealth,#wellbeing, --- Send in a voice message: https://podcasters.spotify.com/pod/show/bhsales/message

Der neue AOP-Katalog stellt uns alle vor Herausforderungen: Operative Leistungen in der gastroenterologischen Endoskopie können in vielen Fällen ambulant durchgeführt werden und bedürfen in anderen Fällen einer stationären Überwachung, doch der neue AOP-Katalog bildet die Heterogenität endoskopischer Leistungen bei weitem nicht ab. Beispiele sind die interventionelle Koloskopie (EMR: endoskopische Mukosaresektion) und die Endoskopie der Gallenwege (ERCP: endoskopisch-retrograde Cholangiopankreatographie). Beide Leistungen sind seit vielen Jahren im AOP enthalten. Allerdings konnte sich eine ambulante Leistungserbringung in den letzten Jahren bei diesen Operationen nicht durchsetzen, da u. a. Strukturvoraussetzungen nicht erfüllt sind und eine spezialisierte Ausbildung in diesen Techniken an stationären Zentren beheimatet ist. Heiner Wedemeyer plaudert mit Ludger Leifeld, Vorsitzender der Kommission Qualität, über die Lücken im System, welche Möglichkeiten wir haben, mit den neuen Vorgaben umzugehen und wie wichtig es ist, als Fachgesellschaft Strukturvorgaben für eine qualitätsgetriebene, sektorübergreifende Versorgung zu machen.

* 라디오주치의 : 순천향의대 가정의학과 유병욱 교수 - 청취자 Q&A : 하지불안정증 (2062) / 만성췌장염 ERCP 시술 (8458) / 담낭용종 수술 후 관리 (현수연) * 이주의 의학정보 : 염민주 리포터 - "잠드는 데 30분 넘게 걸린다면 사망위험 2배 증가" 外_ * 하루한알 의약상식 : 대한약사회 정재훈 약사 - "구충제, 비염에 효과 있을까?"

Um sie auch während der Sommerzeit gut zu unterhalten, senden wir heute und an den nächsten beiden Donnerstagen unser Sommerspecial Komplikationsmanagement in der Endoskopie! Endoskopische Komplikationen und vor allem deren Management haben sich im letzten Jahrzehnt dramatisch gewandelt – vor allem Perforationen werden heutzutage vorwiegend endoskopisch gelöst. In den ersten beiden Teilen erzählt uns Ulrike Denzer, wie wir Perforationen in Ösophagus und Kolon managen und wie meist eine Operation vermieden werden kann. Sie berichtet über eine eigene Fallserie und über eine neue Anwendung einer etablierten Technik auch bei akuten Ösophagusperforationen. Nur in der post-ERCP-Pankreatitis hat sich nichts geändert - wirklich? Henrike Lenzen stellt eine neue Metaanalyse und eine Erfassung in Österreich über die Risiken im Alltag vor. Weiterhin reden wir über die Evidenz zur Pankreatitis-Prophylaxe mit NSAR-Zäpfchen, Hydratation und Pankreasstents.

Approach to workup of cholangitis, chronic cholecystitis, Gallstone Ileus, Cholangiocarcinoma including Klatskin tumor, Carcinoma of GB and Pancreas At the end some house-cleaning on iatrogenic complications of gallstone disease after ERCP and other procedures are discussed (including bile duct injury and bile leak); For SOD refer to previous episode on cholecystitis management and complications of cholecystectomy.

Um sie auch während der Sommerzeit gut zu unterhalten, senden wir heute und an den nächsten beiden Donnerstagen unser Sommerspecial Komplikationsmanagement in der Endoskopie! Endoskopische Komplikationen und vor allem deren Management haben sich im letzten Jahrzehnt dramatisch gewandelt – vor allem Perforationen werden heutzutage vorwiegend endoskopisch gelöst. In den ersten beiden Teilen erzählt uns Ulrike Denzer, wie wir Perforationen in Ösophagus und Kolon managen und wie meist eine Operation vermieden werden kann. Sie berichtet über eine eigene Fallserie und über eine neue Anwendung einer etablierten Technik auch bei akuten Ösophagusperforationen. Nur in der post-ERCP-Pankreatitis hat sich nichts geändert - wirklich? Henrike Lenzen stellt eine neue Metaanalyse und eine Erfassung in Österreich über die Risiken im Alltag vor. Weiterhin reden wir über die Evidenz zur Pankreatitis-Prophylaxe mit NSAR-Zäpfchen, Hydratation und Pankreasstents.

In this episode, Dr. Temara Hajjat and Dr. Jenn Lee discuss with Dr. Roberto Gugig from Stanford's Lucile Packard Children's Hospital the indications, techniques, and potential complications of endoscopic retrograde cholangiopancreatography (ERCP) and endoscopic ultrasound (EUS) in pediatric patients. Dr. Gugig is a pediatric gastroenterologist and Professor of Pediatrics who specializes in advanced endoscopy including ERCP and EUS. Objectives:1. Diving into the science of pediatric ERCP and EUS imaging. 2. Unpacking the intricacies of diagnosing pancreaticobiliary disorders in children using EUS or ERCP. 3. Shedding light on higher complication rates in patients under two years old and how to mitigate them. Support the showAs always, the discussion, views, and recommendations in this podcast are the sole responsibility of the hosts and guests and are subject to change over time with advances in the field.Follow us on Twitter, Facebook and Instagram for all the latest news and upcoming episodes!

The title says it all

Please join Drs. Graham Skelhorne-Gross, Jordan Nantais and Ashlie Nadler from our Emergency General Surgery Team for a discussion on cirrhotic patients.   Child-Pugh Score (https://www.mdcalc.com/calc/340/child-pugh-score-cirrhosis-mortality) ·      Bilirubin, albumin, INR, ascites, encephalopathy ·      Used to predict operative mortality based on cirrhosis severity ·      Mortality in EGS: - Child-Pugh A: 10% electively and 22% emergently - Child-Pugh B: 30% electively and 38% emergently - Child-Pugh C: 80% electively and up to 100% emergently Model for End Stage Liver Disease (MELD) (https://www.mdcalc.com/calc/10437/model-end-stage-liver-disease-meld?utm_source=site&utm_medium=link&utm_campaign=meld_12_and_older) ·      creatinine, bilirubin, INR, and sodium ·      MELD < 20 – 1% increase in mortality with each point increase ·      MELD > 20 – 2% increase in mortality with each point increase Pre-operative Planning ·      Identification of cirrhosis with physical examination, bloodwork and imaging ·      Involvement of other medical services (internal medicine, hepatology, ICU) as needed ·      Cirrhosis optimization, if possible ·      Abdominal wall mapping Unexpected Intraoperative Finding Communicate unexpected findings to the operative team and think of additional adjuncts you may need such as additional ports, topical hemostatic agents or energy devices. Think about why you are in the OR. If its an elective situation and can wait, consider bailing. If its emergent, you may have to do something more definitive. Exposure may be a challenge, you may have to alter your typical approach including where the assistant grabs and retracts. Extra hands are helpful. Bleeding can be a big deal. If possible, map out the abdominal wall ahead of time with cross-sectional imaging. Stay away from varices around the umbilicus or porta Ventral Hernia + Cirrhosis ·      Ideally, control ascites pre-operatively, if you can't consider leaving drains ·      Small (< 2cm) hernias close primarily ·      Larger (>2cm) hernias repair with mesh unless infected filed (controversial) ·      Minimally invasive repairs can be performed Benign Biliary Disease + Cirrhosis ·      Incidence of gallstones is 4-5 times higher in cirrhotic patients ·      Prophylactic laparoscopic cholecystectomy (LC) generally not done ·      LC generally considered acceptable in CP A or B but not C (exceptions: HD instability, gangrenous cholecystitis, hemorrhagic cholecystitis) ·      Cholecystostomy and ERCP are safe References:  Bleszynski, M. et. Al. Acute care and emergency general surgery in patients with chronic liver disease: how can be optimize perioperative care? A review of the literature. 2018. World Journal of Emergency Surgery; 13:32 Mansour A, Watson W, Shayani V, et al. Abdominal operations in patients with cirrhosis: still a major surgical challenge. Surgery. 1997;122:730–5. Yeom SK, Lee CH, Cha SH, Park CM. Prediction of liver cirrhosis, using diagnostic imaging tools. World J Hepatol. 2015 Aug 18;7(17):2069-79. doi: 10.4254/wjh.v7.i17.2069. PMID: 26301049; PMCID: PMC4539400. Jain D, Mahmood E, V-Bandres M, Feyssa E. Preoperative elective transjugular intrahepatic portosystemic shunt for cirrhotic patients undergoing abdominal surgery. Ann Gastroenterol. 2018 May-Jun;31(3):330-337. doi: 10.20524/aog.2018.0249. Epub 2018 Mar 15. PMID: 29720858; PMCID: PMC5924855. **Fellowship application link: https://forms.gle/PiKM2MMQpE5jSAeW7 Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.   If you liked this episode, check out other Emergency General Surgery episode here: https://behindtheknife.org/podcast-category/emergency-general-surgery/

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Welcome to the next installment of the Anesthesia Patient Safety podcast hosted by Alli Bechtel.  This podcast is an exciting journey towards improved anesthesia patient safety.What is your anesthetic plan for ERCP procedures? Tune in today for the conclusion of our special Pro-Con debate series. We are reviewing the final arguments in favor of general endotracheal anesthesia. Spoiler alert: Both sides can agree that keeping patients safe requires a qualified anesthesia professional.Additional sound effects from: Zapsplat.© 2023, The Anesthesia Patient Safety FoundationFor show notes & transcript, visit our episode page at apsf.org: https://www.apsf.org/podcast/137-the-debate-continues-general-endotracheal-anesthesia-for-ercp/

Welcome to the next installment of the Anesthesia Patient Safety podcast hosted by Alli Bechtel.  This podcast is an exciting journey towards improved anesthesia patient safety.What is your anesthetic plan for ERCP procedures? The debate between monitored anesthesia care and general endotracheal anesthesia continues today. We are focusing on the Con-side of the debate in favor of GEA for ERCP with special guest, Luke Janik, who contributed audio clips to the show today.Additional sound effects from: Zapsplat.© 2023, The Anesthesia Patient Safety FoundationFor show notes & transcript, visit our episode page at apsf.org: https://www.apsf.org/podcast/136-the-debate-continues-general-endotracheal-anesthesia-for-ercp/

Welcome to the next installment of the Anesthesia Patient Safety podcast hosted by Alli Bechtel.  This podcast is an exciting journey towards improved anesthesia patient safety. What is your anesthetic plan for ERCP procedures? Tune in today for a special Pro-Con debate show. We are focusing on the Pro-side of the debate in favor of monitored anesthesia care for ERCP and reviewing clinical monitoring, options to provide supplemental oxygen, and development of a safe and effective anesthetic plan.© 2023, The Anesthesia Patient Safety FoundationFor show notes & transcript, visit our episode page at apsf.org: https://www.apsf.org/podcast/135-pros-for-providing-monitored-anesthesia-care-for-ercp/

Welcome to the next installment of the Anesthesia Patient Safety podcast hosted by Alli Bechtel.  This podcast is an exciting journey towards improved anesthesia patient safety.What is your anesthetic plan for ERCP procedures? Tune in today for a special Pro-Con debate show. We are focusing on the Pro-side of the debate in favor of monitored anesthesia care for ERCP with special guest, Samantha Stamper, who contributed audio clips to the show today.Additional sound effects from: Zapsplat.© 2023, The Anesthesia Patient Safety FoundationFor show notes & transcript, visit our episode page at apsf.org: https://www.apsf.org/podcast/134-keeping-patients-safe-during-monitored-anesthesia-care-for-ercp/

Dr Kim Kucharski discusses her article, "Comparison of technical failures and patient-related adverse events associated with 3 widely used mechanical lithotripters for ERCP: insights from the FDA Manufacturer and User Facility Device Experience (MAUDE) database" from the November issue.

Dr. Navin Kumar, an attending Gastroenterologist at Brigham and Women's Hospital, medical educator at Harvard Medical School, and co-founder of the Run the List podcast and host Blake Smith discuss how to approach a patient presenting with acute right-upper quadrant (RUQ) pain. Together, they discuss the various causes of RUQ pain, in addition to how to approach a set of liver function tests (LFTs), differentiating hepatocellular injury from a cholestatic pattern. They then discuss how various forms of imaging (RUQUS, CT) can guide diagnosis and management, leading to a discussion about the use of ERCP and cholecystectomy in such cases. Lastly, the episode closes with a diagnosis and three clinical pearls about RUQ pain and abnormal LFTs.

Host: Jonathan Buscaglia, MD, FASGEGuest Expert: B. Joseph Elmunzer, MD, MSc 

In this podcast episode, Peter B. Cotton, MD, FRCP, FRCS, professor of medicine at the Medical University of South Carolina, discusses the development and invention of the ERCP procedure, the innovation of digestive disease centers and more. Intro :02 Welcome to this episode of Gut Talk :23 About Cotton :23 The interview :37 Where did you grow up? :37 How did you get interested in gastroenterology? 1:38 That [trainees wanting to come to the endoscopy lab and not go to the basic science lab] must have put you in a difficult situation at times. How did you navigate that? 6:12 Could you tell us a little more about what that was like, from an operational perspective, of overseeing the endoscopy center, and perhaps how that role of operating in an endoscopy center as a trainee impacted you innovation in ER cepheid advanced endoscopy? 7:03 How flexible is the shaft of those initial endoscopes, and did you use sedation? 8:49 Is it a correct characterization that the building and innovation and inventions at this early stage in your career was really just to get the job done as opposed to you seeking out a role that was focused on inventing? 9:56 You were the only gastroenterologist at Middlesex for many years, correct? 10:52 How did that transition to Duke occur? … Did that [clinical load] drive a lot of your decision-making or was it more than that? 11:50 Where did the ERCP start? 15:11 How were you able to collaborate with other gastroenterologists and radiologists and surgeons? …What was that collaboration between these investigators that were really trying to drive this procedure forward like back in the Sixties and Seventies? 20:23 Were you able to pass endoscopic videos back and forth, or was that not really the way cases were shared? 21:36 About the Digestive Disorder Center at NUSC and Digestive Diseases Centers 24:43 Has it worked out the way you had envisioned? … What are the potential downfalls as people think about that type of Digestive Health Center model? 27:43 Summary of Cotton's memoir, The Tunnel at the End of the Light: My Endoscopic Journey in Six Decades 31:34 You also have written books for young children as well. What prompted you to writing and teaching one of the most complicated procedures to your book about “Fred the Snake”? 32:10 What are you most excited about with regards to opportunities facing younger gastroenterologists moving forward, and what advice would you give them to seize those opportunities? 34:54 Thank you Peter 36:42 Thanks for listening 36:58 Peter B. Cotton, MD, FRCP, FRCS, is professor of medicine at the Medical University of South Carolina. We'd love to hear from you! Send your comments/questions to guttalkpodcast@healio.com. Follow us on Twitter @HealioGastro @sameerkberry @umfoodoc Disclosures: Berry and Chey report no relevant financial disclosures. Cotton reports no relevant financial disclosures.

Episode 94: Elevated Alk Phos. Akhil explains what to do when the alkaline phosphatase is elevated, including labs, imaging and other studies. This is Rio Bravo qWeek Podcast, your weekly dose of knowledge brought to you by the Rio Bravo Family Medicine Residency Program from Bakersfield, California. Our program is affiliated with UCLA, and it's sponsored by Clinica Sierra Vista, Let Us Be Your Healthcare Home. This podcast was created for educational purposes only. Visit your primary care physician for additional medical advice.Elevated Alk Phos. By Akhil Patel, MS4, American University of the Caribbean. Comments by Hector Arreaza, MD. Serum alkaline phosphatase: When you find elevated serum alkaline phosphatase, you must consider the two most common sources: the liver and bones. Other sources to consider include the third-trimester placenta, intestine, and kidneys. To determine if the abnormal elevation of alkaline phosphatase has clinical significance, you need to consider if it is a physiological or pathological elevation first. Ruling out physiological concerns: Typically, you should rule out physiological causes first as they are fewer and easier to determine via patient history. This can be even quicker to determine but also sometimes bypassed if a patient's history and labs present with more concerning etiologies of pathological elevation.Common causes of physiological elevations in alkaline phosphatase include pregnancy, patients with blood type O and B after eating a fatty meal, and younger children. Pregnancy: During pregnancy women in their third trimester will have elevated serum alk phos from the placenta. Blood type: During digestion, alk phos is released from the intestines in patients of blood type O and B. A postprandial increase can be 1.5 to 2 times the upper limit of normal in these patients, however, there is no clinical significance. Children: Younger children tend to have higher alk phos due to increased bone turnover. You can find a reference range chart online for different age groups. It is possible for alk phos to be up to three times higher in infancy and adolescence reflecting the ages with the highest bone growth velocity. Fun fact: Alkaline Phosphatase (also known as ALP) is a natural enzyme present in raw milk. Complete pasteurization will inactivate the enzyme in milk, therefore, presence of alkaline phosphatase in milk is an indicator of failed pasteurization. This is because the most heat-stable bacteria found in milk, Mycobacterium paratuberculosis, is destroyed by temperatures lower than those required to denature ALP.Evaluation of pathological alkaline phosphatase: Degree of elevation: Another consideration is the level of alk phos elevation. If alk phos is at least four times the upper limit of normal, then cholestasis is the likely cause with many specific etiologies to consider. If alk phos is not markedly elevated (four times the upper limit) then the cause is likely not as specific and many different etiologies should be considered whether hepatic or non-hepatic.  Liver source: Common symptoms: Jaundice, abdominal pain, ascites, easy bruising, nausea and/or vomiting, choluria, acholia or hypocholia, unexplained weight loss, fatigue, or anasarca.If alk phos is elevated along with liver function testing and bilirubin, it is easier to determine the liver etiology (hepatitis, cirrhosis). However, if it is an isolated elevation in alkaline phosphatase, then other sources must be considered more carefully. A helpful test at this point is to look at is GGT or serum 5'-Nucleotidase for elevation. Typically, these will be elevated with alk phos if it is of liver origin. If they are not increased, you should consider bone-related etiologies.-If a hepatic cause is determined, a right upper quadrant ultrasound is the best initial test to determine intrahepatic or extrahepatic causes. This imaging will look at the hepatic parenchyma and bile ducts. Biliary dilation on ultrasound suggests an extrahepatic cause while no dilation suggests an intrahepatic cause. Liver source with biliary dilation: CBD is considered dilated when >6mm. If biliary dilation is present suggesting an extrahepatic cause, ERCP or MRCP is the next best step in visualizing the cause with choledocholithiasis being the most common cause. Other causes to consider: malignant obstruction, primary sclerosing cholangitis strictures, chronic pancreatitis causing strictures, and AIDS cholangiopathy. Malignant obstructions can be from the pancreas, gallbladder, ampulla of vater, bile duct, or distant metastasis. If the results of these tests are inconclusive the next best step is to consider a liver biopsy. Liver source without biliary dilation: Without biliary dilation on ultrasound, there is a larger pool of etiologies to consider for intrahepatic causes: drug toxicity, primary biliary cirrhosis, primary sclerosing cholangitis, viral hepatitis, cholestasis of pregnancy, and total parenteral nutrition (TPN). Tests: Antimitochondrial antibody (AMA) testing is a good place to start at this point which would suggest primary biliary cirrhosis (PBC) and indicate confirmation with a liver biopsy. Other tests to order at this point include hepatitis panel, EBV and CMV, and possibly pregnancy testing. If patient history and these tests are all negative, the next best step to consider is a liver biopsy if alk phos is significantly elevated more than two times the upper limit of normal. Summary: GGT, Liver US, Dilated? -> MRCP, ERCP, CT scan of abdomen and pelvis. Non dilated? AMA, Hepatitis panel, EBV, CMV, pregnancy test.Fun fact: When Alkaline phosphatase is elevated you can order the test called Alkaline Phosphatase isoenzymes. You will get a result with percentages for each isoenzyme: ALPI – intestinal, ALPL – nonspecific, but mainly expressed in liver, bone, and kidney; ALPP – placental, and ALPG – germ cells.  Nonhepatic evaluation:With an isolated alkaline phosphatase elevation and normal GGT or serum 5'-Nucleotidase, the first thing to consider is bone-related pathologies involving high bone turnover: Healing fractures, osteomalacia, Paget's disease of bone, osteogenic sarcoma, bone metastasis, hyperparathyroidism, and hyperthyroidism. Patient history, ordering thyroid and parathyroid function testing, imaging with bone scintigraphy are all important in sorting through the differential of bone-related pathologies. Other extrahepatic diseases to consider that have shown elevated alkaline phosphatase include myeloid metaplasia, peritonitis, diabetes mellitus, subacute thyroiditis, uncomplicated gastric ulcer, and sepsis. Each of these has its own work up and an elevated alk phos level has little significance clinically.Paget's disease of bone: Paget disease of bone is a benign disorder that presents with focal areas of increased bone turnover in one or more skeletal sites. Mostly affects male older adults, but female patients can also be affected. Commonly affects the bones of the pelvis, spine, skull, and long bones. Pain is the most common symptom, and the presentation of the disease may depend on which bones are affected, the extent of involvement, and the presence of complications. Paget's disease of bone may be asymptomatic, incidental elevated serum alkaline phosphatase levels on routine labs or abnormal imaging tests performed for other reasons can point to Paget's disease of bone. Other common symptoms include deafness, and tight hats. Diagnosis is normally done by plain radiography and serum alkaline phosphatase. Radionuclide scans is used to determine the extent of disease. Treatment with nitrogen-containing bisphosphonates (zoledronic acid, risedronate, and alendronate).Complications of the disease include arthritis, gait changes, hearing loss, nerve compression syndromes, and osteosarcoma. Use serum alkaline phosphatase for assessing treatment response. Early diagnosis of Paget disease of bone is key in the management and patients have a better prognosis when treatment is initiated before complications. Consult with a specialist to confirm the diagnosis and start treatment.__________________________Conclusion: Now we conclude our episode number 94 “Elevated Alk Phos”. Elevated Alk Phos can be normal in some circumstances, mainly in pregnancy and childhood. You can start a workup when the alk phos is persistently elevated 4 times above the upper limit of normal. The most common causes can be grouped as hepatic and non-hepatic, and the bones is the most common non-hepatic source. Even without trying, every night you go to bed being a little wiser.This week we thank Hector Arreaza, and Akhil Patel. Audio edition: Suraj Amrutia. Thanks for listening to Rio Bravo qWeek Podcast. If you have any feedback, contact us by email at RioBravoqWeek@clinicasierravista.org, or visit our website riobravofmrp.org/qweek. See you next week! _____________________References:Williams, J., & Nieuwsma, J. (2016). Screening for depression in adults. In J. A. Melin (Ed.), UpToDate. Retrieved February 1, 2017, from https://www.uptodate.com/contents/screening-for-depression-in-adults. Lawrence S Friedman, MD (2020). Approach to the patient with abnormal liver biochemical and function tests. Shilpa Grover (Ed.), UpToDate. Retrieved Maye 12, 2022 from https://www.uptodate.com/contents/approach-to-the-patient-with-abnormal-liver-biochemical-and-function-tests.  Lawrence S Friedman, MD (2020). Enzymatic measures of cholestasis (eg, alkaline phosphatase, 5'-nucleotidase, gamma-glutamyl transpeptidase). Shilpa Grover (Ed.), UpToDate. Retrieved Maye 12, 2022 from https://www.uptodate.com/contents/enzymatic-measures-of-cholestasis-eg-alkaline-phosphatase-5-nucleotidase-gamma-glutamyl-transpeptidase.

What started as pancreatitis, turned into massive transfusion protocol and a visit to interventional radiology. In this episode, Sarah, Katleen, and Marissa discuss a case that took an unexpected turn for the worse. They break down the pathophysiology of pancreatitis, it's treatment, and the nurse's role in the patient's recovery.

Dr Yuki Tanisaka discusses his article, "Efficacy and factors affecting procedure results of short-type single-balloon enteroscopy-assisted ERCP for altered anatomy: a multicenter cohort in JAPAN" from the February issue.

A study in Surgical Endoscopy finds some benefits to delaying gallbladder surgery, at the expense of increased readmissions. Delayed cholecystectomy following endoscopic retrograde cholangio-pancreatography is not associated with worse surgical outcomes | Hospital Medicine Virtual Journal Club

This time our Podcast is full of both important and interesting studies.  We present new evidence on how to treat pancreatic pseudocysts with hydrogen peroxide, the benefit of PPI's on EoE, an large study of endoscopic treatment of appendicitis, and find that our trusty indigo carmine dye spray is still going strong!  Then we have an interesting paper on the appalling effect of mountain sickness on the stomach, transplantation on the risk of polyps and when to stop Barrett's surveillance.  Thanks to our Partners at Pentax medical for your Support ! References reviewed includes;  Laserna MEJ et.al. Efficacy of Therapy for Eosinophilic Esophagitis in Real-World Practice. Clinical Gastroenterology & Hepatology. 18(13):2903-2911.e4, 2020 12. Greuter T et.al. Effectiveness and Safety of High- vs Low-Dose Swallowed Topical Steroids for Maintenance Treatment of Eosinophilic Esophagitis: A Multicenter Observational Study. Clinical Gastroenterology & Hepatology. 2020 Aug 13. Ding W et.al. Endoscopic retrograde appendicitis therapy (ERAT) for management of acute appendicitis. Surgical Endoscopy. 2021 May 13. Becq A et.al. ERCP within 6 or 12 h for acute cholangitis: a propensity score-matched analysis. Surgical Endoscopy. 2021 May 11. Ashkar MH et.al. Increased Risk of Advanced Colonic Adenomas and Timing of Surveillance Colonoscopy Following Solid Organ Transplantation. Digestive Diseases & Sciences. 2021 May 10. Chandrasekhara V et.al. Predicting the need for step-up therapy after EUS-guided drainage of pancreatic fluid collections with lumen-apposing metal stents. Clinical Gastroenterology & Hepatology. 2021 May 06. Messallam AA et.al. Endoscopic Necrosectomy With and Without Hydrogen Peroxide for Walled-off Pancreatic Necrosis: A Multicenter Comparative Study. American Journal of Gastroenterology. 116(4):700-709, 2021 Apr. Shiroma S et.al. Timing of bleeding and thromboembolism associated with endoscopic submucosal dissection for gastric cancer in Japan. Journal of Gastroenterology & Hepatology. 2021 May 07 Yasuda T et.al. Benefits of linked color imaging for recognition of early differentiated-type gastric cancer: in comparison with indigo carmine contrast method and blue laser imaging. Surgical Endoscopy. 35(6):2750-2758, 2021 Jun. Kim JW et.al. Narrowband imaging with near-focus magnification for discriminating the gastric tumor margin before endoscopic resection: A prospective randomized multicenter trial. Journal of Gastroenterology & Hepatology. 35(11):1930-1937, 2020 Nov. Surek A et.al. Risk factors affecting failure of colonoscopic detorsion for sigmoid colon volvulus: a single center experience. International Journal of Colorectal Disease. 36(6):1221-1229, 2021 Jun. Clark G et.al. Transition to quantitative faecal immunochemical testing from guaiac faecal occult blood testing in a fully rolled-out population-based national bowel screening programme. Gut. 70(1):106-113, 2021 Jan. Gachabayov M et.al. Performance evaluation of stool DNA methylation tests in colorectal cancer screening: a systematic review and meta-analysis. Colorectal Disease. 23(5):1030-1042, 2021 05. Forbes N et.al. Association Between Endoscopist Annual Procedure Volume and Colonoscopy Quality: Systematic Review and Meta-analysis. Clinical Gastroenterology & Hepatology. 18(10):2192-2208.e12, 2020 09. Fruehauf H et.al. Evaluation of Acute Mountain Sickness by Unsedated Transnasal Esophagogastroduodenoscopy at High Altitude. Clinical Gastroenterology & Hepatology. 18(10):2218-2225.e2, 2020 09. Goverde A et.al. Yield of Lynch Syndrome Surveillance for Patients With Pathogenic Variants in DNA Mismatch Repair Genes. Clinical Gastroenterology & Hepatology. 18(5):1112-1120.e1, 2020 05. Lamba M et.al. Associations Between Mutations in MSH6 and PMS2 and Risk of Surveillance-detected Colorectal Cancer. Clinical Gastroenterology & Hepatology. 18(12):2768-2774, 2020 11. Omidvar AH et.al. The optimal age to stop endoscopic surveillance of Barrett's esophagus patients based on sex and comorbidity: a comparative cost-effectiveness analysis. Gastroenterology. 2021 May 08.

Arguably, the most exciting thing which has happen in ERCP, in the last 50 years, is EUS and the development of easy to place, 'lumen apposing metal stents' (LAMS).  It's transforming ERCP for the benefits of patients who no longer need to put up with painful PTC's.  Ideally, every region should offer this service but who should be referred for EUS-guided biliary drainage (EUS-BD) and what risks should you quote to your patients?  Monz Ahmed poses some probing questions to Bharat Paranandi and Aaron On in Leeds. 

FDA 连续批准2个治疗胆管癌的靶向药 Lancet 细胞海绵-三叶因子3监测法筛查Barrett食管Nature 胃肠道也有独立的神经系统培米加替尼（Pemigatinib）约20%的肝内胆管癌患者存在成纤维细胞生长因子受体（FGFR）2融合基因突变，培米加替尼（Pemigatinib）是一种选择性FGFR抑制剂。2020年4月，FDA批准培米加替尼治疗复发性的FGFR2基因融合或重排的局部晚期胆管癌。《FIGHT-202研究：培米加替尼治疗晚期胆管癌的临床研究》Lancet Oncology，2020年5月 (1)这个多中心、非盲、单臂、2阶段研究纳入FGFR2融合或重排的晚期胆管癌患者、其他FGF/FGFR基因突变的患者、和没有FGF/FGFR基因突变的患者肱146人。所有入组患者均接受培米加替尼治疗直到疾病进展、不可接受的毒性、撤回同意或医生决定。中位随访17·8个月，FGFR2融合或重排患者中35·5%达到客观缓解（其中3例完全缓解，35人部分缓解）。高磷酸盐血症是最常见的不良事件，49%的患者在研究期间死亡，最常见的原因是疾病进展，与治疗无关。结论：培米加替尼在以前治疗过的发生FGFR2融合或重排的胆管癌患者中均有一定疗效。艾伏尼布（ivosidenib）基因组分析表明，胆管癌中有13%的患者存在IDH1基因突变，艾伏尼布（ivosidenib）是一种新型的小分子靶向异柠檬酸脱氢酶1（IDH1）抑制剂。艾伏尼布2018年被FDA批准用于急性髓细胞性白血病的一线治疗，2020年4月批准用于胆管癌靶向治疗药物。《ClarIDHy研究：针对胆管癌异柠檬酸脱氢酶1（IDH-1）突变的新型靶向疗法的3期临床研究》Lancet Oncology，2020年8月 (2)胆管癌是一种对化疗敏感的癌症。尽管吉西他滨联合顺铂的一线化疗是标准治疗方案，但二线治疗却效果有限。这项国际性、双盲、安慰剂对照的、随机的、3期临床试验中，招募了185例携带IDH-1突变的胆管癌患者，其中大部分患者原发性肝内胆管癌（90%～95%）伴远处转移（92%～93%），随机接受艾伏尼布或安慰剂治疗。中位随访6.9个月时，艾伏尼布组的中位无进展生存期优于安慰剂组（2.7个月 vs 1.4个月，P

There's an uh-oh moment when you're told you have pancreatic cancer. But what happens before that? How do you know if you have the symptoms? In this episode we hear about the pancreatic cancer diagnosis for host Frank Roche. Yep, that's me. And I talk about what led me to being diagnosed with pancreatic cancer nine months ago: stomach cramps, dark urine, jaundice. And I talk about the rapid steps my PCP and gastroenterologist used to diagnose me initially -- sonogram, contrast CT, MRI -- and then the interventions they used to treat my jaundice and stage my cancer -- ERCP and EUS. This show is the beginning of a story. As of the publication of this show I have had 12 rounds of chemo, and I'll soon me moving to radiation and then surgery. In Episode 2 I'll talk about finding the best medical team to help me slay this dragon.