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This saturday, check out two CGH studies on EoE that might change your practice. 1/ Is daily or BID dosing of topical steroid recommended in EOE? 🔥!🔗 doi.org/10.1016/j.cgh.… Reported by Ifrah Fatima Swathi Eluri MD MSCR UNC Department of Medicine Shazia Siddique MD MS Kristle Lee Lynch, MD | Gastroenterology @ UPenn |

#CGH4ALL CGH 📣 Failed stricture detection can lead to unnecessary testing and missed opportunities for treatment! FLIP may accurately identify clinically actionable strictures! Reported by Zaid Ansari 🔗 cghjournal.org/article/S1542-… John E. Pandolfino Nirmala Gonsalves MD

Share your tips for #NourishToFlourish today for World Digestive Health Day 🌏 #WDHD2025 #YourDigestiveHealth 🌸 Tip: Careful for what you consume or feed into your body 🧠🍽👂👀 Share yours 📸 World Gastroenterology Organisation (WGO) Tony Tham Hanna Aberra (MD,PhD) Georgiana Gilca-Blanariu

🦀Don’t miss our final series before the ☀️! #Dysplasia in #IBD 📌#Back2Basics🧵June 2 Katie Dunleavy Romy Chamoun, MD 📌Convo 💬 June 9 Nayantara Coelho 🆓#CME👉🏽bit.ly/MNIBD24-25 🗳️PreB2B👇🏽 Supported by edu grants AbbVie JanssenUS Takeda 🩺Tell us who you are?

#MondayNightIBD 1/#MondayNightIBD #Back2Basics 🎯#dysplasia surveillance in #IBD ✅Incidence ✅Risk factors ✅Surveillance guidelines: when, how often ✅Surveillance in IPAA ✅CLN modalities ✅Dysplasia classification ✅Random vs 🎯'd biopsies ✅Mgmt of dysplasia @ibd_MB @britsocgastro Sunil Dolwani

#MondayNightIBD Tim Raine BSG Sunil Dolwani Gut Journal Morris Gordon John Morris Gaurav Nigam Anjan Dhar Feline_stockholm_syndrome Jonathan Segal 2/Dysplasia & #CRC in #IBD 🔹Historical CRC risk: 2% @10y, 8% 20y, 18% @30y 🔹Good news: CRC incidence has ⬇️in last 20yrs due  to✔️Better therapies w mucosal healing &✔️surveillance programs 🔹Low grade & high grade dysplasia can both⏩CRC or 🟰CRC is already present Benjamin Cohen MD MAS

#MondayNightIBD Tim Raine BSG Sunil Dolwani Gut Journal Morris Gordon John Morris Gaurav Nigam Anjan Dhar Feline_stockholm_syndrome Jonathan Segal 10Y 20y ‏✿‏ ‏յ̇ɹ̤յ̇ΩᒧĨᴝɹ̣ɕ ✿ ⓭ Benjamin Cohen MD MAS NEJM Mount Sinai Division of Gastroenterology Carl Kay, MD Jana G Hashash, MD, MSc Ashwin,M.D Edward Loftus Anita Afzali MD, MPH, MHCM, FACG, AGAF Peter Higgins Jami Kinnucan, MD, FACG, AGAF, FCCF 3/ #MondayNightIBD Risk factors for #dysplasia #CRC in #IBD: 🔹Male, dx< age 20 🔹IBD duration >8–10y 🔹Colitis > 1/3 colon (pancolitis>L-UC) 🔹PSC-IBD = 4x ↑ CRC risk if dx <40y 🔹Inflammatory burden 🔹Tubular colon, stricture 🔹h/o dysplasia 🔹FH of CRC Victor Chedid, MD

#MondayNightIBD Tim Raine BSG Sunil Dolwani Gut Journal Morris Gordon John Morris Gaurav Nigam Anjan Dhar Feline_stockholm_syndrome Jonathan Segal 10Y 20y ‏✿‏ ‏յ̇ɹ̤յ̇ΩᒧĨᴝɹ̣ɕ ✿ ⓭ Benjamin Cohen MD MAS NEJM Mount Sinai Division of Gastroenterology Carl Kay, MD Jana G Hashash, MD, MSc Ashwin,M.D Edward Loftus Anita Afzali MD, MPH, MHCM, FACG, AGAF Peter Higgins Jami Kinnucan, MD, FACG, AGAF, FCCF Victor Chedid, MD Nayantara Coelho Gerardo Calderon AJG - The American Journal of Gastroenterology Reezwana C, MD, FACG David Bruining Sara Horst MD, MPH, FACG Stefan Holubar MD MS Manuel Braga Neto MD, PhD Parakkal Deepak MD, MS, FACG 4/ #MondayNightIBD Surveillance in #IBD w/o dysplasia ⏲️Start 🔹8y of IBD if ≥1/3 colon involved 🔹At dx if PSC 🗓️Q1-5 yrs stratified by risk factors👇 Gastroenterology Fernando Velayos MD MPH doi.org/10.1053/j.gast… 💎Quality Exam= quiescent IBD+👌prep+ HD🔦+experienced🩺+ slow careful exam

#MondayNightIBD Tim Raine BSG Sunil Dolwani Gut Journal Morris Gordon John Morris Gaurav Nigam Anjan Dhar Feline_stockholm_syndrome Jonathan Segal 10Y 20y ‏✿‏ ‏յ̇ɹ̤յ̇ΩᒧĨᴝɹ̣ɕ ✿ ⓭ Benjamin Cohen MD MAS NEJM Mount Sinai Division of Gastroenterology Carl Kay, MD Jana G Hashash, MD, MSc Ashwin,M.D Edward Loftus Anita Afzali MD, MPH, MHCM, FACG, AGAF Peter Higgins Jami Kinnucan, MD, FACG, AGAF, FCCF Victor Chedid, MD Nayantara Coelho Gerardo Calderon AJG - The American Journal of Gastroenterology Reezwana C, MD, FACG David Bruining Sara Horst MD, MPH, FACG Stefan Holubar MD MS Manuel Braga Neto MD, PhD Parakkal Deepak MD, MS, FACG Gastroenterology Fernando Velayos MD MPH American Gastroenterological Association (AGA) Sophie Balzora, MD, FACG Siew Ng Gaurav Syal, MD MHDS Parul Tandon DO PhD FRCPC Shrinivas Bishu Joshua M. Steinberg, MD Tauseef Ali MD, FACG AGAF FACP Keith Siau 5/Dysplasia🔍in IPAA/Retained rectum 🔹BSG Gut Journal doi.org/10.1136/gutjnl… • q1yr if CRC/dysplasia @✂️ • q1–3yrs if PSC, chronic pouchitis, cuffitis.. 🔹American Gastroenterological Association (AGA) • q1yr if h/o CRC/dysplasia, PSC, severe pouchitis • Individualize in low-risk pt 👇cont...6/

Katie Dunleavy #MondayNightIBD Tim Raine BSG Sunil Dolwani Gut Journal Morris Gordon John Morris Gaurav Nigam Anjan Dhar Feline_stockholm_syndrome Jonathan Segal 10Y 20y ‏✿‏ ‏յ̇ɹ̤յ̇ΩᒧĨᴝɹ̣ɕ ✿ ⓭ Benjamin Cohen MD MAS NEJM Mount Sinai Division of Gastroenterology Carl Kay, MD Jana G Hashash, MD, MSc Ashwin,M.D Edward Loftus Anita Afzali MD, MPH, MHCM, FACG, AGAF Peter Higgins Jami Kinnucan, MD, FACG, AGAF, FCCF Victor Chedid, MD Nayantara Coelho Gerardo Calderon AJG - The American Journal of Gastroenterology Reezwana C, MD, FACG David Bruining Sara Horst MD, MPH, FACG Stefan Holubar MD MS Manuel Braga Neto MD, PhD Parakkal Deepak MD, MS, FACG Gastroenterology Fernando Velayos MD MPH American Gastroenterological Association (AGA) Sophie Balzora, MD, FACG Siew Ng Gaurav Syal, MD MHDS Parul Tandon DO PhD FRCPC Shrinivas Bishu Joshua M. Steinberg, MD Tauseef Ali MD, FACG AGAF FACP Keith Siau Maia Kayal MD Laura Raffals, MD Priscila Santiago, MD Edward Barnes MD MPH 6/ #MondayNightIBD IBD Colonoscopy Surveillance: 💎HighDef> StandardDef🔦 ➕Virtual Chromo prn, or Dye Chromo (DCE) if ⏫risk (h/o dysplasia, PSC) 🎨DCE needs👌prep, no🔥 🔎Most dysplasia in IBD is visible (Paris polyp Classification) 🔎Invisible dysplasia dx by random biopsies

Katie Dunleavy #MondayNightIBD Tim Raine BSG Sunil Dolwani Gut Journal Morris Gordon John Morris Gaurav Nigam Anjan Dhar Feline_stockholm_syndrome Jonathan Segal 10Y 20y ‏✿‏ ‏յ̇ɹ̤յ̇ΩᒧĨᴝɹ̣ɕ ✿ ⓭ Benjamin Cohen MD MAS NEJM Mount Sinai Division of Gastroenterology Carl Kay, MD Jana G Hashash, MD, MSc Ashwin,M.D Edward Loftus Anita Afzali MD, MPH, MHCM, FACG, AGAF Peter Higgins Jami Kinnucan, MD, FACG, AGAF, FCCF Victor Chedid, MD Nayantara Coelho Gerardo Calderon AJG - The American Journal of Gastroenterology Reezwana C, MD, FACG David Bruining Sara Horst MD, MPH, FACG Stefan Holubar MD MS Manuel Braga Neto MD, PhD Parakkal Deepak MD, MS, FACG Gastroenterology Fernando Velayos MD MPH American Gastroenterological Association (AGA) Sophie Balzora, MD, FACG Siew Ng Gaurav Syal, MD MHDS Parul Tandon DO PhD FRCPC Shrinivas Bishu Joshua M. Steinberg, MD Tauseef Ali MD, FACG AGAF FACP Keith Siau Maia Kayal MD Laura Raffals, MD Priscila Santiago, MD Edward Barnes MD MPH 7/ #MondayNightIBD #B2B 🔹 Old way: 4-quadrant random bx q10cm (32 total) 🔹Now: High-yield biopsies: 🔸HD scope +Targeted bx of abnormal mucosa on WL or chromo, resection of polyps 🔸 Random bx still of value sp. if ⬆️risk (PSC, invisible dysplasia), poor visualization/prep

Katie Dunleavy #MondayNightIBD Tim Raine BSG Sunil Dolwani Gut Journal Morris Gordon John Morris Gaurav Nigam Anjan Dhar Feline_stockholm_syndrome Jonathan Segal 10Y 20y ‏✿‏ ‏յ̇ɹ̤յ̇ΩᒧĨᴝɹ̣ɕ ✿ ⓭ Benjamin Cohen MD MAS NEJM Mount Sinai Division of Gastroenterology Carl Kay, MD Jana G Hashash, MD, MSc Ashwin,M.D Edward Loftus Anita Afzali MD, MPH, MHCM, FACG, AGAF Peter Higgins Jami Kinnucan, MD, FACG, AGAF, FCCF Victor Chedid, MD Nayantara Coelho Gerardo Calderon AJG - The American Journal of Gastroenterology Reezwana C, MD, FACG David Bruining Sara Horst MD, MPH, FACG Stefan Holubar MD MS Manuel Braga Neto MD, PhD Parakkal Deepak MD, MS, FACG Gastroenterology Fernando Velayos MD MPH American Gastroenterological Association (AGA) Sophie Balzora, MD, FACG Siew Ng Gaurav Syal, MD MHDS Parul Tandon DO PhD FRCPC Shrinivas Bishu Joshua M. Steinberg, MD Tauseef Ali MD, FACG AGAF FACP Keith Siau Maia Kayal MD Laura Raffals, MD Priscila Santiago, MD Edward Barnes MD MPH 8/Dysplasia is classified: -Resectable clearly defined polypoid <2 cm, no invasive features▶️Endo resection -❗️>2 cm or complex: ▶️🔦resection based on features, local expertise (often need ESD, not EMR) - Unresectable, cancer - Invisible 💬 Unsure? refer to IBD center !

Katie Dunleavy #MondayNightIBD Tim Raine BSG Sunil Dolwani Gut Journal Morris Gordon John Morris Gaurav Nigam Anjan Dhar Feline_stockholm_syndrome Jonathan Segal 10Y 20y ‏✿‏ ‏յ̇ɹ̤յ̇ΩᒧĨᴝɹ̣ɕ ✿ ⓭ Benjamin Cohen MD MAS NEJM Mount Sinai Division of Gastroenterology Carl Kay, MD Jana G Hashash, MD, MSc Ashwin,M.D Edward Loftus Anita Afzali MD, MPH, MHCM, FACG, AGAF Peter Higgins Jami Kinnucan, MD, FACG, AGAF, FCCF Victor Chedid, MD Nayantara Coelho Gerardo Calderon AJG - The American Journal of Gastroenterology Reezwana C, MD, FACG David Bruining Sara Horst MD, MPH, FACG Stefan Holubar MD MS Manuel Braga Neto MD, PhD Parakkal Deepak MD, MS, FACG Gastroenterology Fernando Velayos MD MPH American Gastroenterological Association (AGA) Sophie Balzora, MD, FACG Siew Ng Gaurav Syal, MD MHDS Parul Tandon DO PhD FRCPC Shrinivas Bishu Joshua M. Steinberg, MD Tauseef Ali MD, FACG AGAF FACP Keith Siau Maia Kayal MD Laura Raffals, MD Priscila Santiago, MD 9/👻If Invisible dysplasia: ▶️Repeat 🔦HD +DCE by IBD expert, careful exam + extensive biopsies; IF: 🚨Unresectable, multifocal LGD, HGD→ colectomy✂️ ✅ Unifocal LGD--> ✂️or close surveillance ✅No dysplasia → close surveillance See recs👇Gastroenterology doi.org/10.1053/j.gast…

Katie Dunleavy #MondayNightIBD Tim Raine BSG Sunil Dolwani Gut Journal Morris Gordon John Morris Gaurav Nigam Anjan Dhar Feline_stockholm_syndrome Jonathan Segal 10Y 20y ‏✿‏ ‏յ̇ɹ̤յ̇ΩᒧĨᴝɹ̣ɕ ✿ ⓭ Benjamin Cohen MD MAS NEJM Mount Sinai Division of Gastroenterology Carl Kay, MD Jana G Hashash, MD, MSc Ashwin,M.D Edward Loftus Anita Afzali MD, MPH, MHCM, FACG, AGAF Peter Higgins Jami Kinnucan, MD, FACG, AGAF, FCCF Victor Chedid, MD Nayantara Coelho Gerardo Calderon AJG - The American Journal of Gastroenterology Reezwana C, MD, FACG David Bruining Sara Horst MD, MPH, FACG Stefan Holubar MD MS Manuel Braga Neto MD, PhD Parakkal Deepak MD, MS, FACG Gastroenterology Fernando Velayos MD MPH American Gastroenterological Association (AGA) Sophie Balzora, MD, FACG Siew Ng Gaurav Syal, MD MHDS Parul Tandon DO PhD FRCPC Shrinivas Bishu Joshua M. Steinberg, MD Tauseef Ali MD, FACG AGAF FACP Keith Siau Maia Kayal MD Laura Raffals, MD Priscila Santiago, MD Waqqas Afif, MD 10/Summary IBD & Dysplasia Surveillance 📅 Start 8y post-dx (UC/CD) if >1/3 colon involved q1-5 yrs per risk factors 🗓️Start at dx if PSC, q1yr 🔍 HD-WLE, VCE/DCE: targeted+random bx 🍄Most dysplasia is visible: resectable by endo vs Sx 👻If high risk invisible dysplasia ->✂️

PreConvo Poll1️⃣ 🆓#CME👉🏽bit.ly/PrabhuPre 32M panUC >8yrs in remission on VDZ. 🔦CLN: multiple pseudopolyps, but no adenomas 🔬Random bx: no dysplasia His father had colon cancer in his late 40’s. 🗓️Per AGA guidelines, when should he repeat CLN (😉Answer in June2 B2B🧵)

PreConvo Poll2️⃣ 🆓#CME👉🏽bit.ly/PrabhuPre In a patient with #IBD undergoing surveillance colonoscopy 🔦, which #dysplasia can be resected by endoscopy (😉answer in June2 B2B🧵)

📣#GI #CRSurgery Join us now for this convo led by Nayantara Coelho Aline Charabaty, MD, FACG, AGAF What factors impact the type of ✂️ you recommend for #dysplasia in #IBD ✅Endo 📸 in this post 🗳️Vignette👇🏽& share your 💬 &expertise w us Support by edu grants AbbVie JanssenUS Takeda

#MondayNightIBD Aline Charabaty, MD, FACG, AGAF AbbVie JanssenUS Takeda Nisha Loganantharaj David Fudman, MD Jordan Axelrad, MD, MPH Tanvi Dhere,MD David M. Schwartzberg, MD Stefan Holubar MD MS Edward Loftus Jami Kinnucan, MD, FACG, AGAF, FCCF Pär Myrelid Adam Faye MD MS 70M pancolitis+PSC, on ADAL, o/w healthy 🔦Surv CLN: depressed lesion in sigmoid (📸 👆🏽) 🔬Bx of the lesion: high grade dysplasia. Random bx proximal rectum: indefinite dysplasia, distal rectum: nml What do you recommend?  🔑TPC= total proctocolectomy; IRA= ileorectal anastomosis

Nayantara Coelho David M. Schwartzberg, MD #MondayNightIBD AbbVie JanssenUS Takeda Nisha Loganantharaj David Fudman, MD Jordan Axelrad, MD, MPH Tanvi Dhere,MD Stefan Holubar MD MS Edward Loftus Jami Kinnucan, MD, FACG, AGAF, FCCF Pär Myrelid Adam Faye MD MS Dr Jonny Blackwell Dr Feza Remzi Shrinivas Bishu How worried do you get about risk of dehydration w ileostomy in a frail vs Fit vs elderly ? Any role for L hemi & colostomy w close endo surveillance ? Stefan Holubar MD MS Adam Faye MD MS Beatriz Gros Paula Sousa Neilanjan Nandi, MD, FACG, AGAF, FCCF, FACP Tauseef Ali MD, FACG AGAF FACP

Aline Charabaty, MD, FACG, AGAF Nayantara Coelho David M. Schwartzberg, MD #MondayNightIBD AbbVie JanssenUS Takeda Nisha Loganantharaj David Fudman, MD Jordan Axelrad, MD, MPH Tanvi Dhere,MD Stefan Holubar MD MS Edward Loftus Jami Kinnucan, MD, FACG, AGAF, FCCF Pär Myrelid Dr Jonny Blackwell Dr Feza Remzi Shrinivas Bishu Beatriz Gros Paula Sousa Neilanjan Nandi, MD, FACG, AGAF, FCCF, FACP Tauseef Ali MD, FACG AGAF FACP Certainly part of the consideration. Would have to discuss ability to manage the ostomy/output etc - but given concern for future invisible dysplasia (assuming otherwise doing well)- upfront EI (or possibly IPAA) may be preferred