1/ Any takers on whats this #GITwitter

Reviewing principles of single enteroscopy w our #GIFellows

Mini-Tweetorial

I follow “STIR”

S:Scope forward
T:Tube forward until 50 cm on the scope
I:Inflate balloon
R:Reduce

Dont advance tube when is inflated

2/ Some practical tips that I use during enteroscopy

Lubricate tube & balloon before insertion
Flush water through tube channel as well as scope, helps scope slide better through small bowel
I like my simethicone in small bowel

Image by Japanese Enteroscopy Study Grp

3/ During the procedure:

I find keeping shaft of scope as straight as possible more helpful (image on right)

Glucagon helps

Once in jejunum, suction & using the dials to manuever turns helps in advancing more than pushing & torque

Have ur assist keep tube straight

4/ Other lessons I learned

Once deep in SB, think of the tube as bite block in EGD

Often have to stand far from pt to keep scope straight

In RNY- often the angulated entry point is biliary limb (been wrong before)

Abd pressure helps

Dont forget shoe covers

5/ Deep enteroscopy can be challenging & feel not rewarding at times

Need lots of patience if you decide to undertake

Devices can be challenging to get through due to looping - I find duraclips to go most easily among TTS clips

The END/

What are your pearls #GITwitter ?