GiT Updates and More

🔥Slim therapeutic gastroscope with large working channel - a game changer in upper GI endoscopy - 7.9 mm outer diameter - 3.2 mm working channel (allows for instrument/utensil maneuvering while suctioning water or air )

✳️ Antiemetics: • 5-HT3 antagonists – Ondansetron (post-chemotherapy-post operative ) • D2 antagonists – Metoclopramide, Domperidone (gastroparesis, migraine) • H1 blockers – Diphenhydramine, Meclizine (motion sickness, vertigo) • Neurokinin-1 (NK1)antagonists – Aprepitant (chemo-induced) • Steroids – Dexamethasone-adjunct in CINV (chemotherapy induced nausea and vomiting ) • Others – Benzodiazepines (anticipatory vomiting), Cannabinoids

Acute Pancreatitis

🌟 Exocrine Pancreatic insufficiency in IBD : Around 5–20% of patients with IBD may have some degree of exocrine pancreatic dysfunction. Often overlooked, EPI can mimic IBD flares with symptoms like diarrhea, bloating, and weight loss. 🔑 Key points: Connection: Inflammation, autoimmunity, meds, surgery, malnutrition Clues: Steatorrhea, weight loss, vitamin deficiencies Diagnosis: Fecal elastase-1, stool fat test Treatment: Pancreatic enzyme replacement + ADEK supplementation 💡 Takeaway: Always consider EPI when your IBD patient isn’t improving despite controlled disease. Early diagnosis + therapy = better outcomes!

Screening for latent TB before biologic therapy

✅Small & stable PancreaticCysts may not require ongoing surveillance In the PACYFIC trial, cysts <15 mm & slow-growing (<2.5 mm/year) showed very low risk of malignancy — comparable to the general population

New brain-targeting anti-obesity peptides (GLP-1, GIP, and dual agonists) access brain sites, such as the area postrema and arcuate nucleus, where they engage neurons controlling appetite, energy use, and reward response. By tapping into these circuits, they help suppress hunger and drive weight loss.

Tips for Polypectomy

Proposed treatment algorithm for Achalasia.LMH (Laparoscopic Heller myotomy), PD (pneumatic dilation), POEM (peroral endoscopic myotomy)

Current Surgical Therapy, Cameron 2023.

Comparison between EGJOO and Achalasia

❇️ Types Of Achalasia 1. Type I (Classic Achalasia) - Features: Minimal or no contractility in the esophageal body. - Manometry: Incomplete relaxation of the lower esophageal sphincter (LES) and absence of esophageal pressurization. - Clinical Implication: Represents the most severe loss of esophageal muscle function, often referred to as "classic" achalasia. 2. Type II (Achalasia with Panesophageal Pressurization) - Features: Intermittent, simultaneous pressurization throughout the esophagus. - Manometry: Incomplete LES relaxation and panesophageal pressurization in at least 20% of swallows. - Clinical Implication: This type often responds best to treatment, as the esophagus still generates pressure waves, although they are uncoordinated. 3. Type III (Spastic Achalasia) - Features: Premature (spastic) or abnormal contractions in the lower esophagus. - Manometry: Incomplete LES relaxation with premature or spastic distal esophageal contractions in at least 20% of swallows. - Clinical Implication: Describes a more spastic and less common variant, which may require different therapeutic approaches compared to Types I and II. 🔆 Type II usually has the best prognosis following common interventions, while Type III often requires specialized treatments such as peroral endoscopic myotomy (POEM).

❇️Types Of ACHALAISA : 1. Type I (Classic Achalasia) ▪️Features: Minimal or no contractility in the esophageal body. ▪️Manometry: Incomplete relaxation of the lower esophageal sphincter (LES) and absence of esophageal pressurization. ▪️Clinical Implication: Represents the most severe loss of esophageal muscle function, often referred to as "classic" achalasia. 2. Type II (Achalasia with Panesophageal Pressurization) Features: Intermittent, simultaneous pressurization throughout the esophagus. Manometry: Incomplete LES relaxation and panesophageal pressurization in at least 20% of swallows. Clinical Implication: This type often responds best to treatment, as the esophagus still generates pressure waves, although they are uncoordinated. 3. Type III (Spastic Achalasia) Features: Premature (spastic) or abnormal contractions in the lower esophagus. Manometry: Incomplete LES relaxation with premature or spastic distal esophageal contractions in at least 20% of swallows. Clinical Implication: Describes a more spastic and less common variant, which may require different therapeutic approaches compared to Types I and II.

❇️ American Foregut Society (AFS) to describe different Hiatus Grades : 🔹Grade 1 (Normal) ▪️EGJ is intact, with a normal flap valve present. ▪️Minimal hiatal diameter (about 1cm). ▪️Represents a fully functional anti reflux barrier. 🔹Grade 2 (Mild Disruption) ▪️Partial loss of the intra-abdominal esophageal length. ▪️Slightly looser hiatus (1–2cm diameter). ▪️Flap valve either absent or less defined. ▪️Early signs of reflux-related disruption. 🔹Grade 3 (Moderate Disruption) ▪️Hiatal hernia axial length up to 2cm, or hiatus aperture of 2–3cm. ▪️Flap valve is missing. ▪️Indicates notable anatomical change that can affect reflux control. 🔹Grade 4 (Severe Disruption) ▪️Axial length greater than 2cm, or hiatus aperture larger than 3cm. ▪️No flap valve present. ▪️Represents a high degree of anatomical disruption, often resulting in severe reflux symptoms.

❇️ Types of Hiatal Hernias: 🔹Type I : Sliding Hiatal Hernia Most common variant [approximately 95% of cases] Characterized by : - Gastroesophageal (GE) junction's upward displacement - Migration into the thoracic cavity 🔹Types II-IV: Paraoesophageal Hernias (PEHs) These types are less prevalent but potentially more complex. 🔹Type II: Rolling Hiatal Hernia - The stomach herniates into the thoracic cavity - GE junction maintains its normal anatomical position - Often referred to as a "pure" paraoesophageal hernia 🔹Type III: Mixed Hiatal Hernia - Combines features of Types I and II - Both the stomach and GE junction herniate into the thorax - Most common form of paraoesophageal hernia 🔹Type IV: Complex Hiatal Hernia - Characterized by herniation of additional organs and May include : ( Colon - Spleen - Pancreas - Small intestine )

❇️ Hill Classification – Gastroesophageal flap valve (GERD risk): ▪️Grade I : Prominent fold , tightly closed around scope. ▪️Grade II : Fold present , opens intermittently. Mostly open and close with Respiration. ▪️Grade III : Minimal fold , valve remains open. ▪️Grade IV : No fold , wide open lumen. Mostly associated with Hiatal Hernia. 🔆 Higher grades correlate with reflux severity .