• Only reverse the anticoagulation if GI bleeding is life-threatening- if you do then prothrombin complex concentrate is the preferred option.
• Try to restart anticoagulation and/or antiplatelet the day after the procedure both for bleeders and routine procedures.
• If a sessile polyp is > 1 cm then removal by hot snare is preferred to cold snare.
• If you remove a > 2 cm polyp in the right colon, then close the defect with clips.
• Hemospray is ok to use as definitive monotherapy.
• CTA has replaced tagged RBC scan.
• If chronic HBV in age >30 and viral load >2,000 can consider treatment regardless of transaminases.
• Don’t bother with primary or secondary prophylaxis for SBP anymore.
• If confusion in liver disease is not HE, then OSA is next most likely cause.
• No need to survey liver simple cysts, hemangiomas, FNH
• If you find a colon cancer in someone < 50 then send for genetic testing.
• If you find > 20 adenomas cumulative in someone then send for genetic testing.
• Fluids should be LR 100-150 cc/hr in acute pancreatitis.
• In acute pancreatitis can go straight to low fat diet (does not need NPO or liquid trial).
• Pancreas replacements enzymes not beneficial for chronic abdominal pain.
• Don’t get fecal elastase as part of routine diarrhea workup unless other reasons to.
• Gets pH study in suspected extra-esophageal GERD.
• Food allergy testing not beneficial in EoE.
• Retroactive IBD drug level approach is just as good as proactive.
• G-POEM is preferred in refractory gastroparesis.
• Entyvio superior to Humira in UC.
• Entyvio works better as first line therapy and not when given as second line.
• Infliximab is the preferred anti-tnf in UC.
• Avoid small molecules if pregnant.
• Deep ulcers and peri-anal disease top predictors for aggressive Crohn’s.
• Most Crohn’s strictures will need resection.
• Get colonoscopy 6-12 mos post-op after Crohn’s resection.
• If high risk GIM (extensive, incomplete, FMH, minority, immigrant) then repeat EGD in 3 yrs.
• Abdominal-phrenic dyssynergia is common cause of bloating.
• 9 min colonoscopy withdrawal time is optimal.
• Examine the right colon twice.
• IMC is counted as HGD in rectal cancers so can manage with ESD or emr.
• ESD better in esophageal nodules that are larger than 2 cm.
Pearls: ACG Postgraduate Course Recap from Dr. Fyock
• Only reverse the anticoagulation if GI bleeding is life-threatening- if you do then prothrombin complex concentrate is the preferred option.
• Try to restart anticoagulation and/or antiplatelet the day after the procedure both for bleeders and routine procedures.
• If a sessile polyp is > 1 cm then removal by hot snare is preferred to cold snare.
• If you remove a > 2 cm polyp in the right colon, then close the defect with clips.
• Hemospray is ok to use as definitive monotherapy.
• CTA has replaced tagged RBC scan.
• If chronic HBV in age >30 and viral load >2,000 can consider treatment regardless of transaminases.
• Don’t bother with primary or secondary prophylaxis for SBP anymore.
• If confusion in liver disease is not HE, then OSA is next most likely cause.
• No need to survey liver simple cysts, hemangiomas, FNH
• If you find a colon cancer in someone < 50 then send for genetic testing.
• If you find > 20 adenomas cumulative in someone then send for genetic testing.
• Fluids should be LR 100-150 cc/hr in acute pancreatitis.
• In acute pancreatitis can go straight to low fat diet (does not need NPO or liquid trial).
• Pancreas replacements enzymes not beneficial for chronic abdominal pain.
• Don’t get fecal elastase as part of routine diarrhea workup unless other reasons to.
• Gets pH study in suspected extra-esophageal GERD.
• Food allergy testing not beneficial in EoE.
• Retroactive IBD drug level approach is just as good as proactive.
• G-POEM is preferred in refractory gastroparesis.
• Entyvio superior to Humira in UC.
• Entyvio works better as first line therapy and not when given as second line.
• Infliximab is the preferred anti-tnf in UC.
• Avoid small molecules if pregnant.
• Deep ulcers and peri-anal disease top predictors for aggressive Crohn’s.
• Most Crohn’s strictures will need resection.
• Get colonoscopy 6-12 mos post-op after Crohn’s resection.
• If high risk GIM (extensive, incomplete, FMH, minority, immigrant) then repeat EGD in 3 yrs.
• Abdominal-phrenic dyssynergia is common cause of bloating.
• 9 min colonoscopy withdrawal time is optimal.
• Examine the right colon twice.
• IMC is counted as HGD in rectal cancers so can manage with ESD or emr.
• ESD better in esophageal nodules that are larger than 2 cm.
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