Thread by @BilalMohammadMD

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 ?