Steven Bollipo Profile picture
Aug 16, 2020 5 tweets 7 min read Read on X
One of the reasons we fuss so much about the accuracy of melaena description is that we use it to arbitrarily divide the GI bleed 🩸 as upper or lower although there are many caveats. Sometimes the distinction UGIB or LGIB is necessary because of who takes the patient! #turf
Melaena (assuming correctly described) can still be from right colonic or small bowel bleed and bright red blood can also be from a brisk upper GI bleed. Has the time come to see them all as GI bleeds and work on them?
How accurate is the description of melaena over the phone?
Here is a little poll to see how GI bleeds are managed globally.

Who takes GI bleeds in your hospital? GIs or Surgeons?
#GItwitter #UGIB #LGIB
What’s your referral practice with UGIB vs LGIB? Does the shade of melaena/melena impact your decision?
@kate_oakland @ShradhaGuptaMD @BilalMohammadMD @drkeithsiau @DCharabaty @Samir_Grover @MichaelScaffidi @RashidLui @SunilAminMD @SanchezLunaMD @KM_Pawlak @drdeepakmadhu
UGIB vs LGIB based on the shade of melena, admit with GI or Sx
Please join the discussion.
@DrHarryThomas @DrReddyGI @purnie_mae @AparnaGoelMD @ginorthshore @GI_Pearls @Uk_BowelDoc @sachdevmd @drmanmeetm @SiwanTG @SWexner @PPockney @SoMe4endoscopy @me4_so

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More from @stevenbollipo

Sep 23, 2020
The best thing about 2020 for me is the number of papers from Twitter discussions with Twitter friends as co-authors.
What has been your experience with #twitter2paper ?
Do you have any tips?
Here are my tips:
1. Every twitter debate is a potential paper
2. Learn the art of DM
Read 7 tweets
Sep 18, 2020
Nothing gets my heart rate going like varices!
Here is my quick tip when banding. I dip the scope with banding cap in a small cup of Simethicone before insertion. Much clearer views without the frothy saliva!
Please share your quick tips for managing varices! #livertwitter
Read 5 tweets
Sep 13, 2020
Quick tips on #polypectomy
Another awesome summary of the thread from @enrrikke
Special thanks to @RKeswaniMD @swatigp for their papers on #coldsnarepolypectomy
Thanks everyone for your tips & tricks! Feel free to add more.
#gitwitter ImageImageImageImage
Read 4 tweets
Sep 9, 2020
Quick tips for small #polypectomy
Smaller the polyp, longer the drama! But why?
Here are my 10 tips, share yours!
1. Ask: is this necessary?
2. Take it when you see it, may never find it again!
3. Position at 6 O' clock
4. Don't move around while waiting for snare, don't lose!
5. Keep your eye on the polyp, don't even blink
6. Clear the fluid above and below
7. Choose a small cold snare, don't open it too much
8. If struggling with position, try cold biopsy forceps instead
9. If snare is slipping, deflate the colon. Don't lift!
10. Check if trap is on!
Read 6 tweets
Sep 8, 2020
Here is the amazing summary of the many gems in the quick tips for #colonoscopy thread.
Thanks @enrrikke for this beautiful work! ImageImageImageImage
Read 4 tweets
Sep 4, 2020
Quick tips for #colonoscopy
Please share your tips/tricks
Here is mine:
When the cecum is frothy & full of bubbles, go into terminal ileum which is the source of froth, and squirt Simethicone in there and then come back to cecum. Crystal clear cecum!
Thank me later!
The same trick in #gastroscopy : When using simethicone, attack the source!
If the stomach is frothy, put some simethicone in oesophagus and in the pylorus, come back to the stomach to rinse and clean as normal! @Samir_Grover
Read 4 tweets

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