Weekly GI-Chat Digest — UC Dilemmas, SCAD vs Ischemia, LST Strategy & More (Apr 19 – 25 2025)
Concise take-aways from the EndoCollab WhatsApp gastroenterology forum: top differentials, pearls, and practical action points in one quick read.
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1. “Early UC vs Eosinophilic colitis?” (19 Apr)
• Endoscopic appearance points to UC but histology only shows eosinophils.
• Could still represent very-early UC or parasitic / allergic colitis.
• Plan: 3-day wet-mount stools ± family screening; review diet if relapsing. 5-ASA ± short steroid taper will help regardless of final aetiology. Repeat colonoscopic biopsies 6 mo after steroid-free interval.
▸ Treat empirically with 5-ASA now.▸ Rule out helminths/allergy.▸ Scheduled re-biopsy off steroids to nail the diagnosis.
2. “Evidence vs Expert Opinion”
• Guidelines are a framework; RCTs > cohorts > case series > expert opinion (Level V)
• Real-world care must balance evidence with feasibility, local expertise and cost.
▸ Default to high-level evidence when feasible, but be pragmatic.
3. 80 y male, massive LGI bleed + diverticulosis
• Differential: ischemic colitis at watershed zones (Griffiths/Sudeck) vssegmental colitis associated with diverticulosis (SCAD).
• CT-angiography ⇢ “no ischemia,” but NOMI can be missed; consider repeat review with radiologist.
• Jejunal thickening on CT; DBE unrevealing.
• Risk factors: HD, DM, CAD.
▸ Supportive care, hydration.▸ Empiric cipro + metronidazole or mesalazine if SCAD suspected.▸ Await biopsies; revisit imaging if clinical course worsens.
4. 30 mm Cecal LST-NG (posted 20–21 Apr)
• Endoscopic impression: Paris 0-IIa, LST-NG, JNET IIa, Kudo III/IIIL, no suspicion of deep invasion.
• Options debated: ESD (guideline-recommended en bloc when >2 cm) vs standard or underwater EMR vs EFTR if appendiceal orifice involved.
• Underwater EMR favoured by several if complete en bloc feasible.
▸ Map exact relation to IC valve/appendix.▸ Choose technique that ensures R0 resection with acceptable risk (local expertise driven).
5. Chemo-related severe diarrhoea / neutropenic enterocolitis
• Symptom control: racecadotril, loperamide, ondansetron, bismuth, S. boulardii.
• Broad-spectrum cover: cefepime + metronidazole or Pip/Tazo; ceftriaxone alone inadequate for pseudomonas.
• Screen for C. difficile; CT if peritoneal signs.
▸ Early fluids & empiric anti-pseudomonal antibiotics when neutropenia suspected.
6. PSC patient, INR 3, suspected UC (24 Apr)
• Colonoscopic biopsy deemed low-bleeding-risk even with INR 3 (INR ≠ perfect bleeding surrogate).
• Post-biopsy bleeding likely from active colitis; start mesalazine.
• PSC-UC management same as classic UC; sulfasalazine only for joint disease or cost issues.
• Surveillance colonoscopy every 1-2 yr with NBI/HD chromo.
▸ No need to correct INR before routine biopsies.▸ Target deep mucosal healing; add UDCA for PSC liver disease.
7. White plaques in left colon
• Appearances fit colonic pseudolipomatosis / xanthomas (gas-related microcystic change).
• Benign; histology often normal unless lipid-laden macrophages captured.
▸ Document; no therapy needed.
8. Anal pain in 75 y female
• Retroflexion shows fissure, hemorrhoids, condyloma and possible ulcerated SCC.
• Biopsy essential to exclude malignancy.
▸ Excisional/targeted biopsy; HPV status; manage fissure/hemorrhoids symptomatically.
9. Misc. Resources & Requests
• Homemade 3-D-printed ERCP trainer shared (≈ USD 4 cost).
• Need for nurse-level endoscope disinfection course flagged.
• Article requests: pancreatic-duct stricture dilation (2020 Pancreatology), octreotide for oesophageal perforation, ectopic sebaceous glands, etc.
▸ Consider adding “Endoscope Reprocessing 101” module to EndoCollab Nurse track.▸ Share DOI-requested PDFs when copyright permits.
Rapid-Fire Pearls
Segmental colitis in diverticulosis (SCAD): treat like mild–mod UC (mesalazine ± abx); watch for ischemia masquerading.
INR ≠ bleeding risk for mucosal biopsies—platelet function and local factors matter more.
Underwater EMR is gaining traction for LST-NG ≤ 30 mm, reducing need for ESD in centres without high-volume expertise.
Neutropenic enterocolitis: fourth-gen cephalosporin + anaerobe cover is standard initial therapy.
Colonic pseudolipomatosis: iatrogenic, disappears; differentiate from chicken-skin mucosa which flags nearby neoplasia.
Want to join these discussions live? Our private WhatsApp group—featured in today’s digest—is open now via our Founding Member Plan. Get priority access, expert opinions, and lifetime founder pricing.
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