# Crohn's Disease — GCMD Library living collection

Everything in the library about Crohn's disease — built automatically from dossiers that name it.

Updated: n/a · 6 episodes · 84 cited statements

## Episodes
### Surgical Management
- [Update Course Rewind: 2020 ERAS](https://qa.library.globalcastmd.com/watch/update-course-rewind-2020-eras-3718) — podcast · 11:54 · [machine version](https://qa.library.globalcastmd.com/watch/update-course-rewind-2020-eras-3718.md)

### Evidence & Research
- [Journal of Pediatric Surgery Article Review: September 2021](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-september-2021-4527) — podcast · 11:16 · [machine version](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-september-2021-4527.md)

### Case-Based Learning
- [Inflammatory Bowel Disease (IBD) - Samir Pandya: Update Course 2014](https://qa.library.globalcastmd.com/watch/inflammatory-bowel-disease-samir-pandya-update-course-2014-655) — video · 28:36 · [machine version](https://qa.library.globalcastmd.com/watch/inflammatory-bowel-disease-samir-pandya-update-course-2014-655.md)
- [Inflammatory Bowel Disease: Update Course 2015](https://qa.library.globalcastmd.com/watch/inflammatory-bowel-disease-update-course-2015-987) — video · 13:49 · [machine version](https://qa.library.globalcastmd.com/watch/inflammatory-bowel-disease-update-course-2015-987.md)
- [Inflammatory Bowel Disease: Update Course 2014](https://qa.library.globalcastmd.com/watch/inflammatory-bowel-disease-update-course-2014-1042) — video · 28:36 · [machine version](https://qa.library.globalcastmd.com/watch/inflammatory-bowel-disease-update-course-2014-1042.md)
- [Colorectal Quiz Episode 26: Perianal Crohn's Disease](https://qa.library.globalcastmd.com/watch/colorectal-quiz-episode-26-perianal-crohn-s-disease-4890) — podcast · 23:58 · [machine version](https://qa.library.globalcastmd.com/watch/colorectal-quiz-episode-26-perianal-crohn-s-disease-4890.md)

## Chapters
- [0:00](https://qa.library.globalcastmd.com/watch/inflammatory-bowel-disease-samir-pandya-update-course-2014-655?t=0) Case 1: Imaging modalities for fibrostenotic and fistulizing Crohn's disease (Ep 1)
- [7:00](https://qa.library.globalcastmd.com/watch/inflammatory-bowel-disease-samir-pandya-update-course-2014-655?t=420) Case 1: Surgical management of perianal abscess with ileal stricture (Ep 1)
- [15:00](https://qa.library.globalcastmd.com/watch/inflammatory-bowel-disease-samir-pandya-update-course-2014-655?t=900) Seton techniques and perianal fistula outcomes (Ep 1)
- [20:00](https://qa.library.globalcastmd.com/watch/inflammatory-bowel-disease-samir-pandya-update-course-2014-655?t=1200) Isolated terminal ileal Crohn's as distinct entity (Ep 1)
- [23:00](https://qa.library.globalcastmd.com/watch/inflammatory-bowel-disease-samir-pandya-update-course-2014-655?t=1380) Case 2: Surgical approach to refractory ulcerative colitis (Ep 1)
- [0:00](https://qa.library.globalcastmd.com/watch/inflammatory-bowel-disease-update-course-2015-987?t=0) Crohn's Disease Case: Terminal Ileal Stricture with Ureteral Involvement (Ep 2)
- [3:05](https://qa.library.globalcastmd.com/watch/inflammatory-bowel-disease-update-course-2015-987?t=185) Ulcerative Colitis Case: Colectomy and J-Pouch Considerations (Ep 2)
- [8:27](https://qa.library.globalcastmd.com/watch/inflammatory-bowel-disease-update-course-2015-987?t=507) Cancer Risk and Surveillance in Ulcerative Colitis (Ep 2)
- [8:52](https://qa.library.globalcastmd.com/watch/inflammatory-bowel-disease-update-course-2015-987?t=532) Indeterminate Colitis Management and J-Pouch Controversies (Ep 2)
- [12:58](https://qa.library.globalcastmd.com/watch/inflammatory-bowel-disease-update-course-2015-987?t=778) Balancing Surgical Outcomes and Fertility Preservation (Ep 2)
- [0:00](https://qa.library.globalcastmd.com/watch/inflammatory-bowel-disease-update-course-2014-1042?t=0) Imaging Modalities for Crohn's Disease Diagnosis (Ep 3)
- [3:47](https://qa.library.globalcastmd.com/watch/inflammatory-bowel-disease-update-course-2014-1042?t=227) Surgical Management of Fistulizing and Fibrostenotic Crohn's (Ep 3)
- [12:45](https://qa.library.globalcastmd.com/watch/inflammatory-bowel-disease-update-course-2014-1042?t=765) Perianal Disease Management and Outcomes (Ep 3)
- [18:24](https://qa.library.globalcastmd.com/watch/inflammatory-bowel-disease-update-course-2014-1042?t=1104) Isolated Terminal Ileal Crohn's Disease (Ep 3)
- [20:46](https://qa.library.globalcastmd.com/watch/inflammatory-bowel-disease-update-course-2014-1042?t=1246) Ulcerative Colitis Surgical Management (Ep 3)
- [0:00](https://qa.library.globalcastmd.com/watch/update-course-rewind-2020-eras-3718?t=0) Introduction to ERAS in Pediatric Surgery (Ep 4)
- [2:15](https://qa.library.globalcastmd.com/watch/update-course-rewind-2020-eras-3718?t=135) Case Presentation: 16-Year-Old with Ileocecal Stricture (Ep 4)
- [4:25](https://qa.library.globalcastmd.com/watch/update-course-rewind-2020-eras-3718?t=265) Discharge Readiness and Family Expectations (Ep 4)
- [5:39](https://qa.library.globalcastmd.com/watch/update-course-rewind-2020-eras-3718?t=339) Preoperative Optimization and Anesthesia Buy-In (Ep 4)
- [7:40](https://qa.library.globalcastmd.com/watch/update-course-rewind-2020-eras-3718?t=460) Institutional Implementation Strategy (Ep 4)
- [8:20](https://qa.library.globalcastmd.com/watch/update-course-rewind-2020-eras-3718?t=500) ERAS Definition, Goals, and Outcomes (Ep 4)
- [10:56](https://qa.library.globalcastmd.com/watch/update-course-rewind-2020-eras-3718?t=656) Closing and Resources (Ep 4)
- [0:08](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-september-2021-4527?t=8) Early Feeding vs Traditional Feeding After Neonatal Intestinal Anastomosis (Ep 5)
- [5:10](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-september-2021-4527?t=310) Clinical Predictive Score for Meckel's Diverticulum (Ep 5)
- [6:53](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-september-2021-4527?t=413) Perianal Symptoms and Crohn's Disease in Children (Ep 5)
- [0:05](https://qa.library.globalcastmd.com/watch/colorectal-quiz-episode-26-perianal-crohn-s-disease-4890?t=5) Introduction and case presentation setup (Ep 6)
- [1:49](https://qa.library.globalcastmd.com/watch/colorectal-quiz-episode-26-perianal-crohn-s-disease-4890?t=109) Case presentation and diagnostic workup discussion (Ep 6)
- [5:12](https://qa.library.globalcastmd.com/watch/colorectal-quiz-episode-26-perianal-crohn-s-disease-4890?t=312) Imaging workup and biologic risks (Ep 6)
- [7:51](https://qa.library.globalcastmd.com/watch/colorectal-quiz-episode-26-perianal-crohn-s-disease-4890?t=471) Surgical planning and timing (Ep 6)
- [11:21](https://qa.library.globalcastmd.com/watch/colorectal-quiz-episode-26-perianal-crohn-s-disease-4890?t=681) Operative findings and surgical technique (Ep 6)
- [15:22](https://qa.library.globalcastmd.com/watch/colorectal-quiz-episode-26-perianal-crohn-s-disease-4890?t=922) Postoperative course and endoscopic findings (Ep 6)
- [16:46](https://qa.library.globalcastmd.com/watch/colorectal-quiz-episode-26-perianal-crohn-s-disease-4890?t=1006) Biologic therapy timing and seton management (Ep 6)
- [21:52](https://qa.library.globalcastmd.com/watch/colorectal-quiz-episode-26-perianal-crohn-s-disease-4890?t=1312) Summary and closing (Ep 6)

## Statements
Every statement is attributed, typed, and timestamped; the link is the citation.
- In pediatric patients, unlike adult patients, the first presenting factor for Crohn's disease can often be perianal disease. — Jason Frischer (clinical) [Ep 6 · 9:29](https://qa.library.globalcastmd.com/watch/colorectal-quiz-episode-26-perianal-crohn-s-disease-4890?t=569)
- Male gender over the age of 10, and presence of a fistula are risk factors with much higher incidence of Crohn's disease being diagnosed in patients presenting with perianal lesions to the emergency room. — Jason Frischer (epidemiological) [Ep 6 · 9:00](https://qa.library.globalcastmd.com/watch/colorectal-quiz-episode-26-perianal-crohn-s-disease-4890?t=540)
- The mucosa heals first compared to skin in perianal disease, so leaving a mucosal opening without a seton risks recurrent abscess when biologics heal the mucosa. — Jason Frischer (clinical) [Ep 6 · 12:31](https://qa.library.globalcastmd.com/watch/colorectal-quiz-episode-26-perianal-crohn-s-disease-4890?t=751)
- Making a large cruciate incision and packing a perianal abscess in a child with undiagnosed Crohn's disease may result in non-healing and potentially require colostomy or ileostomy. — Jason Frischer (clinical) [Ep 6 · 13:12](https://qa.library.globalcastmd.com/watch/colorectal-quiz-episode-26-perianal-crohn-s-disease-4890?t=792)
- The highest risk factors for lymphoma with biologic therapy are male gender, teenage age, and combination therapy with methotrexate. — Jason Frischer (clinical) [Ep 6 · 6:52](https://qa.library.globalcastmd.com/watch/colorectal-quiz-episode-26-perianal-crohn-s-disease-4890?t=412)
- Real risks of biologic agents include infectious complications such as tuberculosis and risk of lymphoma. — Cristine Velazco (clinical) [Ep 6 · 6:29](https://qa.library.globalcastmd.com/watch/colorectal-quiz-episode-26-perianal-crohn-s-disease-4890?t=389)
- When the colonoscope cannot intubate the terminal ileum, capsule endoscopy or fecal calprotectin can be used to aid diagnosis. — Cristine Velazco (clinical) [Ep 6 · 3:47](https://qa.library.globalcastmd.com/watch/colorectal-quiz-episode-26-perianal-crohn-s-disease-4890?t=227)
- If terminal ileum cannot be intubated, gastroenterologists may treat presumptively and re-scope after a few months of treatment when inflammation has decreased. — Jason Frischer (clinical) [Ep 6 · 4:36](https://qa.library.globalcastmd.com/watch/colorectal-quiz-episode-26-perianal-crohn-s-disease-4890?t=276)
- Setons should remain in place for at least 6 months to allow the inflammatory tract to become non-inflammatory. — Lisa McMahon (clinical) [Ep 6 · 17:54](https://qa.library.globalcastmd.com/watch/colorectal-quiz-episode-26-perianal-crohn-s-disease-4890?t=1074)
- Before removing a seton, the bottom must look better, drainage must be better, the patient must be symptom-free, and they must have reached steady state of biologic (loading dose plus at least 3 more doses, typically 2-3 months from start). — Jason Frischer (clinical) [Ep 6 · 19:23](https://qa.library.globalcastmd.com/watch/colorectal-quiz-episode-26-perianal-crohn-s-disease-4890?t=1163)
- Inflammatory markers including fecal calprotectin, ESR, and CRP should be checked before removing a seton to ensure systemic disease is under control. — Jason Frischer (clinical) [Ep 6 · 19:55](https://qa.library.globalcastmd.com/watch/colorectal-quiz-episode-26-perianal-crohn-s-disease-4890?t=1195)
- The initial Remicade paper from 1998 or 1999 in the New England Journal of Medicine was on perianal disease and demonstrated improved healing time and improved length of time between recurrence when combination of seton and infliximab is used versus either separately. — Jason Frischer (clinical) [Ep 6 · 20:49](https://qa.library.globalcastmd.com/watch/colorectal-quiz-episode-26-perianal-crohn-s-disease-4890?t=1249)
- Remicade (infliximab) has the most literature on healing perianal disease; Humira also has good evidence but less literature; Stelara and vedolizumab are sometimes used with less information available. — Lisa McMahon (clinical) [Ep 6 · 20:27](https://qa.library.globalcastmd.com/watch/colorectal-quiz-episode-26-perianal-crohn-s-disease-4890?t=1227)
- Literature shows about a 10% response rate for perianal fistulas even without biologics if a seton is placed and removed, with much better outcomes with biologics. — Lisa McMahon (epidemiological) [Ep 6 · 19:12](https://qa.library.globalcastmd.com/watch/colorectal-quiz-episode-26-perianal-crohn-s-disease-4890?t=1152)
- Source control of infection must be achieved before starting immunosuppressive therapy including steroids and biologics. — Jason Frischer (clinical) [Ep 6 · 17:17](https://qa.library.globalcastmd.com/watch/colorectal-quiz-episode-26-perianal-crohn-s-disease-4890?t=1037)
- If an abscess is not adequately drained, reimaging should be performed before giving biologics or steroids. — Jason Frischer (clinical) [Ep 6 · 17:17](https://qa.library.globalcastmd.com/watch/colorectal-quiz-episode-26-perianal-crohn-s-disease-4890?t=1037)
- Hydrogen peroxide is preferred over methylene blue for identifying fistula tracts because it is neater; 3% hydrogen peroxide in a syringe with 16-20 gauge angiocath is used with a speculum in the anus. — Jason Frischer (clinical) [Ep 6 · 14:15](https://qa.library.globalcastmd.com/watch/colorectal-quiz-episode-26-perianal-crohn-s-disease-4890?t=855)
- When a fistula opening cannot be found despite hydrogen peroxide testing, a seton should not be placed at that time to avoid creating a hole where there isn't one. — Jason Frischer (clinical) [Ep 6 · 14:54](https://qa.library.globalcastmd.com/watch/colorectal-quiz-episode-26-perianal-crohn-s-disease-4890?t=894)
- For recurrent patients requiring repeat seton placement, repeat imaging should be obtained before seton removal. — Lisa McMahon (clinical) [Ep 6 · 18:45](https://qa.library.globalcastmd.com/watch/colorectal-quiz-episode-26-perianal-crohn-s-disease-4890?t=1125)
- It is common to have perianal disease in Crohn's; this patient had a delay in diagnosis and had perianal disease for quite some time with multiple skin tags and fissures. — Lisa McMahon (clinical) [Ep 6 · 7:24](https://qa.library.globalcastmd.com/watch/colorectal-quiz-episode-26-perianal-crohn-s-disease-4890?t=444)
- Children presenting with Crohn's disease for the first time with a perianal or perirectal abscess often have non-colonic small intestinal disease. — Samir Pandya (clinical) [Ep 1 · 3:00](https://qa.library.globalcastmd.com/watch/inflammatory-bowel-disease-samir-pandya-update-course-2014-655?t=180)
- Perianal abscesses in Crohn's disease are unlikely to heal without fecal diversion because bowel continuity slows healing. — Samir Pandya (opinion) [Ep 1 · 10:00](https://qa.library.globalcastmd.com/watch/inflammatory-bowel-disease-samir-pandya-update-course-2014-655?t=600)
- Modern TNF inhibitor drugs are effective at healing perianal disease in Crohn's, potentially allowing avoidance of fecal diversion in selected patients. — Samir Pandya (clinical) [Ep 1 · 11:00](https://qa.library.globalcastmd.com/watch/inflammatory-bowel-disease-samir-pandya-update-course-2014-655?t=660)
- Patients and parents would rather deal with a chronic perianal problem than manage a stoma. — Samir Pandya (opinion) [Ep 1 · 12:00](https://qa.library.globalcastmd.com/watch/inflammatory-bowel-disease-samir-pandya-update-course-2014-655?t=720)
- Most Crohn's perianal abscesses are not single; when draining a perianal abscess in Crohn's disease, there are usually several fistulas present. — Samir Pandya (clinical) [Ep 1 · 13:00](https://qa.library.globalcastmd.com/watch/inflammatory-bowel-disease-samir-pandya-update-course-2014-655?t=780)
- Setons are very effective for perianal fistulas and should be used more often in pediatric surgery than they currently are. — Samir Pandya (opinion) [Ep 1 · 14:00](https://qa.library.globalcastmd.com/watch/inflammatory-bowel-disease-samir-pandya-update-course-2014-655?t=840)
- It is less morbid to perform laparoscopic diversion in 15% of patients whose perianal disease fails to heal than to give 100% of patients an ostomy upfront. — Samir Pandya (opinion) [Ep 1 · 15:00](https://qa.library.globalcastmd.com/watch/inflammatory-bowel-disease-samir-pandya-update-course-2014-655?t=900)
- Crohn's patients can develop peristomal fistulas as a complication of stoma creation. — Samir Pandya (clinical) [Ep 1 · 16:00](https://qa.library.globalcastmd.com/watch/inflammatory-bowel-disease-samir-pandya-update-course-2014-655?t=960)
- Crohn's disease affects the entire GI tract as a chronic disorder, even when only one segment shows active stricturing disease. — Samir Pandya (clinical) [Ep 1 · 17:00](https://qa.library.globalcastmd.com/watch/inflammatory-bowel-disease-samir-pandya-update-course-2014-655?t=1020)
- A cutting seton requires 360-degree tension on tissue to actively divide it, whereas a non-cutting seton is placed loosely to allow drainage and gradual fibrosis without active cutting. — Samir Pandya (clinical) [Ep 1 · 19:00](https://qa.library.globalcastmd.com/watch/inflammatory-bowel-disease-samir-pandya-update-course-2014-655?t=1140)
- For duodenal Crohn's strictures, endoscopic and fluoroscopic dilation combined with Remicade can be effective, making the stricture more pliable and allowing weight gain. — Samir Pandya (clinical) [Ep 1 · 21:00](https://qa.library.globalcastmd.com/watch/inflammatory-bowel-disease-samir-pandya-update-course-2014-655?t=1260)
- Isolated terminal ileal Crohn's disease may be a separate disease entity from perianal or diffuse Crohn's disease because it behaves very differently, with prolonged remission after resection. — Samir Pandya (opinion) [Ep 1 · 22:00](https://qa.library.globalcastmd.com/watch/inflammatory-bowel-disease-samir-pandya-update-course-2014-655?t=1320)
- Patients with isolated terminal ileal Crohn's disease should be considered for earlier resection before starting Remicade because of the favorable long-term outcomes after resection. — Samir Pandya (opinion) [Ep 1 · 22:00](https://qa.library.globalcastmd.com/watch/inflammatory-bowel-disease-samir-pandya-update-course-2014-655?t=1320)
- Pediatric IBD patients referred for surgery are often in horrible nutritional shape because GI physicians view surgery as failure and carry patients on medical therapy for too long. — Samir Pandya (opinion) [Ep 1 · 23:00](https://qa.library.globalcastmd.com/watch/inflammatory-bowel-disease-samir-pandya-update-course-2014-655?t=1380)
- Patients with severe ulcerative colitis who are emaciated, hypoalbuminemic, on steroids, and in poor nutritional status often require three-stage surgery: subtotal colectomy with end ileostomy, then subsequent J-pouch creation. — Samir Pandya (clinical) [Ep 1 · 24:00](https://qa.library.globalcastmd.com/watch/inflammatory-bowel-disease-samir-pandya-update-course-2014-655?t=1440)
- Patients with ulcerative colitis recover incredibly fast after subtotal colectomy, much faster than after the subsequent J-pouch operation. — Samir Pandya (clinical) [Ep 1 · 25:00](https://qa.library.globalcastmd.com/watch/inflammatory-bowel-disease-samir-pandya-update-course-2014-655?t=1500)
- The best ulcerative colitis patients ever look is when they have their end ileostomy after subtotal colectomy, before J-pouch creation. — Samir Pandya (opinion) [Ep 1 · 26:00](https://qa.library.globalcastmd.com/watch/inflammatory-bowel-disease-samir-pandya-update-course-2014-655?t=1560)
- Ongoing rectal bleeding from the rectal stump after subtotal colectomy for ulcerative colitis is rare but can be managed with local therapy. — Samir Pandya (clinical) [Ep 1 · 27:00](https://qa.library.globalcastmd.com/watch/inflammatory-bowel-disease-samir-pandya-update-course-2014-655?t=1620)
- Endorectal dissection technique (similar to Hirschsprung surgery) can be performed safely for ulcerative colitis J-pouch even in relatively sick patients, as long as a diverting ileostomy is created. — Samir Pandya (clinical) [Ep 1 · 28:00](https://qa.library.globalcastmd.com/watch/inflammatory-bowel-disease-samir-pandya-update-course-2014-655?t=1680)
- Continued bleeding from the rectal stump after subtotal colectomy for ulcerative colitis can force earlier-than-anticipated completion of the J-pouch procedure. — Samir Pandya (clinical) [Ep 1 · 29:00](https://qa.library.globalcastmd.com/watch/inflammatory-bowel-disease-samir-pandya-update-course-2014-655?t=1740)
- Between stage 1 and stage 2 of ulcerative colitis surgery, patients often gain 20 to 30 pounds, which can make the subsequent operation technically harder. — Samir Pandya (clinical) [Ep 1 · 30:00](https://qa.library.globalcastmd.com/watch/inflammatory-bowel-disease-samir-pandya-update-course-2014-655?t=1800)
- Although there is evidence that early feeding in adult patients after intestinal surgery is beneficial, the authors didn't find any benefit in neonates — Mikko Pakarinen (clinical) [Ep 5 · 2:37](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-september-2021-4527?t=157)
- Babies with blood in their stool causing a decrease in hemoglobin has always been a red flag sign for Meckel's diverticulum — Mikko Pakarinen (clinical) [Ep 5 · 5:10](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-september-2021-4527?t=310)
- The Cincinnati study included all children aged 0-18 years within a 15-mile radius who presented with perianal disease — Iris Lim Butel (clinical) [Ep 5 · 7:23](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-september-2021-4527?t=443)
- Only 3% of children presenting with perianal symptoms were diagnosed with Crohn's disease — Iris Lim Butel (epidemiological) [Ep 5 · 8:51](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-september-2021-4527?t=531)
- No children under the age of 1 year with perianal abscess ended up having Crohn's disease within the study period — Iris Lim Butel (epidemiological) [Ep 5 · 9:02](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-september-2021-4527?t=542)
- Higher rates of Crohn's disease were seen in older children, particularly over the age of 10 — Julian Goddard (epidemiological) [Ep 5 · 9:16](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-september-2021-4527?t=556)
- Many patients in the study had fissures, which are very common in children — Iris Lim Butel (epidemiological) [Ep 5 · 9:41](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-september-2021-4527?t=581)
- Quite a few children with Crohn's disease present with perirectal abscess rather than typical GI symptoms like abdominal pain and diarrhea (clinical) [Ep 5 · 10:23](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-september-2021-4527?t=623)
- Pediatric surgery knowledge is growing exponentially, making it impossible to stay up to date — Todd Ponsky (opinion) [Ep 4 · 0:00](https://qa.library.globalcastmd.com/watch/update-course-rewind-2020-eras-3718?t=0)
- The 16-year-old patient with tight ileocecal stricture was given protein shakes preoperatively for nutritional optimization — Kurt Heise (clinical) [Ep 4 · 2:15](https://qa.library.globalcastmd.com/watch/update-course-rewind-2020-eras-3718?t=135)
- The patient drank high carbohydrate clear liquids on the day of operation, stopping one hour before surgery — Kurt Heise (clinical) [Ep 4 · 2:45](https://qa.library.globalcastmd.com/watch/update-course-rewind-2020-eras-3718?t=165)
- Total IV fluids for the case was less than 4 ccs per kilo per hour using ERAS anesthesia protocol — Kurt Heise (clinical) [Ep 4 · 3:05](https://qa.library.globalcastmd.com/watch/update-course-rewind-2020-eras-3718?t=185)
- Postoperatively, multimodal analgesia included Tylenol, Toradol, and Neurontin — Kurt Heise (clinical) [Ep 4 · 3:30](https://qa.library.globalcastmd.com/watch/update-course-rewind-2020-eras-3718?t=210)
- The patient was allowed to drink immediately after surgery and started to snack that night — Kurt Heise (clinical) [Ep 4 · 3:50](https://qa.library.globalcastmd.com/watch/update-course-rewind-2020-eras-3718?t=230)
- The patient was hep locked, on regular diet, pain well controlled, walking with PT, and having bowel movements on postoperative day one — Kurt Heise (clinical) [Ep 4 · 4:05](https://qa.library.globalcastmd.com/watch/update-course-rewind-2020-eras-3718?t=245)
- The patient was discharged the evening after partial colectomy when physiologically ready — Kurt Heise (clinical) [Ep 4 · 4:20](https://qa.library.globalcastmd.com/watch/update-course-rewind-2020-eras-3718?t=260)
- Setting expectations with families about discharge goals preoperatively through heavy counseling is important — Kurt Heise (clinical) [Ep 4 · 5:20](https://qa.library.globalcastmd.com/watch/update-course-rewind-2020-eras-3718?t=320)
- For Crohn's disease patients on TNF inhibitors, surgery should be delayed 2-4 weeks from the last infusion if possible (clinical) [Ep 2 · 1:38](https://qa.library.globalcastmd.com/watch/inflammatory-bowel-disease-update-course-2015-987?t=98)
- After surgery for Crohn's disease, TNF inhibitor therapy can be restarted at 2 weeks postoperatively if active disease is seen in other parts of the bowel, or at 4 weeks if disease is less aggressive (clinical) [Ep 2 · 1:38](https://qa.library.globalcastmd.com/watch/inflammatory-bowel-disease-update-course-2015-987?t=98)
- TNF inhibitors are associated with increased wound complications rather than anastomotic complications specifically (clinical) [Ep 2 · 2:34](https://qa.library.globalcastmd.com/watch/inflammatory-bowel-disease-update-course-2015-987?t=154)
- The decision to divert versus perform single-stage J-pouch is made intraoperatively based on ease of pouch descent, tissue health, and presence of tension (clinical) [Ep 2 · 3:59](https://qa.library.globalcastmd.com/watch/inflammatory-bowel-disease-update-course-2015-987?t=239)
- Timing of surgery in ulcerative colitis is determined by failure of medical therapy, which includes not just uncontrolled disease but also intolerable complications of medical management such as growth failure and long-term side effects of anti-TNF drugs and steroids (clinical) [Ep 2 · 4:38](https://qa.library.globalcastmd.com/watch/inflammatory-bowel-disease-update-course-2015-987?t=278)
- Surveillance colonoscopy is now an acceptable alternative to mandatory colectomy for ulcerative colitis patients, typically performed yearly (clinical) [Ep 2 · 8:02](https://qa.library.globalcastmd.com/watch/inflammatory-bowel-disease-update-course-2015-987?t=482)
- Only about 20% of patients with ulcerative colitis develop colon cancer by 20 years from the time of original diagnosis (epidemiological) [Ep 2 · 8:27](https://qa.library.globalcastmd.com/watch/inflammatory-bowel-disease-update-course-2015-987?t=507)
- For indeterminate colitis, conservative treatment options include diversion with ileostomy to observe the colon's response (clinical) [Ep 2 · 9:38](https://qa.library.globalcastmd.com/watch/inflammatory-bowel-disease-update-course-2015-987?t=578)
- For extensively diseased indeterminate colitis, subtotal colectomy with ileostomy provides a large specimen for pathologic determination of disease type (clinical) [Ep 2 · 9:38](https://qa.library.globalcastmd.com/watch/inflammatory-bowel-disease-update-course-2015-987?t=578)
- J-pouch procedures in indeterminate colitis carry more risk than in definitive ulcerative colitis (clinical) [Ep 2 · 9:38](https://qa.library.globalcastmd.com/watch/inflammatory-bowel-disease-update-course-2015-987?t=578)
- Creating a J-pouch in a patient who turns out to have Crohn's disease creates significantly more challenges than anticipated (clinical) [Ep 2 · 10:30](https://qa.library.globalcastmd.com/watch/inflammatory-bowel-disease-update-course-2015-987?t=630)
- Thin asthenic females with indeterminate colitis do not do well with J-pouch procedures (clinical) [Ep 2 · 10:57](https://qa.library.globalcastmd.com/watch/inflammatory-bowel-disease-update-course-2015-987?t=657)
- For indeterminate colitis, a stepwise approach (rather than immediate J-pouch) allows time to gather more diagnostic information (clinical) [Ep 2 · 11:09](https://qa.library.globalcastmd.com/watch/inflammatory-bowel-disease-update-course-2015-987?t=669)
- J-pouch procedures have a learning curve in terms of technical aspects (opinion) [Ep 2 · 11:31](https://qa.library.globalcastmd.com/watch/inflammatory-bowel-disease-update-course-2015-987?t=691)
- For pediatric J-pouch procedures, the rectum can be divided laparoscopically and averted or stapled at the columns, with the J-pouch created externally and anvil placed for EEA anastomosis, because adult staplers cannot fit into the pelvis in smaller children (clinical) [Ep 2 · 11:58](https://qa.library.globalcastmd.com/watch/inflammatory-bowel-disease-update-course-2015-987?t=718)
- Children presenting with Crohn's disease for the first time with a perianal or perirectal abscess often have non-colonic small intestinal disease. — Corn (clinical) [Ep 3 · 1:23](https://qa.library.globalcastmd.com/watch/inflammatory-bowel-disease-update-course-2014-1042?t=83)
- MR enterography provides information about both the stricture anatomy and the chronicity of disease, helping determine whether a stricture is chronic and fibrotic (unlikely to resolve with medication) or potentially responsive to medical therapy. — Arnie (clinical) [Ep 3 · 3:51](https://qa.library.globalcastmd.com/watch/inflammatory-bowel-disease-update-course-2014-1042?t=231)
- For duodenal Crohn's strictures, endoscopic and fluoroscopic dilation combined with Remicade can successfully manage the stricture, making it more pliable and allowing weight gain. — Samir (clinical) [Ep 3 · 18:24](https://qa.library.globalcastmd.com/watch/inflammatory-bowel-disease-update-course-2014-1042?t=1104)
- Isolated terminal ileal Crohn's disease in teenagers behaves differently from perianal or diffuse Crohn's disease, with recurrence potentially delayed 10-15 years after resection, allowing symptom-free passage through puberty into adulthood. (clinical) [Ep 3 · 19:20](https://qa.library.globalcastmd.com/watch/inflammatory-bowel-disease-update-course-2014-1042?t=1160)
- For isolated terminal ileal Crohn's disease, resection may be considered earlier than biologic therapy because patients can have very long symptom-free intervals (10-15 years) before recurrence. (opinion) [Ep 3 · 20:29](https://qa.library.globalcastmd.com/watch/inflammatory-bowel-disease-update-course-2014-1042?t=1229)
- In Europe, ultrasound is generally advocated for basically everything, but in sophisticated pediatric radiology departments, MRI remains the standard diagnostic tool for chronic inflammatory bowel disease, though ultrasound use is increasing. — Philip (clinical) [Ep 3 · 21:01](https://qa.library.globalcastmd.com/watch/inflammatory-bowel-disease-update-course-2014-1042?t=1261)
- Patients with ulcerative colitis referred for surgery are often in horrible shape because GI doctors view surgery as failure and carry patients on medical therapy for so long that by the time surgeons see them, they are emaciated with low albumin, poor nutritional status, and have been on steroids and multiple other medications. — Arnie (opinion) [Ep 3 · 23:37](https://qa.library.globalcastmd.com/watch/inflammatory-bowel-disease-update-course-2014-1042?t=1417)
- After subtotal colectomy with end ileostomy for severe ulcerative colitis, patients get better incredibly fast, faster than after the subsequent J-pouch operation, and often look their best when they have their stoma. — Corn (clinical) [Ep 3 · 24:29](https://qa.library.globalcastmd.com/watch/inflammatory-bowel-disease-update-course-2014-1042?t=1469)
- Ongoing rectal bleeding from the rectal stump after subtotal colectomy for ulcerative colitis can occur and may force earlier completion proctectomy than anticipated, though this can be managed with local therapy. — Arnie (clinical) [Ep 3 · 25:00](https://qa.library.globalcastmd.com/watch/inflammatory-bowel-disease-update-course-2014-1042?t=1500)
- One problem with three-stage colectomy is that patients often gain 20-30 pounds between stage 1 and 2, making the subsequent operation harder. — Samir (clinical) [Ep 3 · 26:17](https://qa.library.globalcastmd.com/watch/inflammatory-bowel-disease-update-course-2014-1042?t=1577)
- If a patient has received infliximab within the last 6 weeks before surgery, there is evidence (both adult and pediatric) that a three-stage procedure should probably be performed due to increased complication risk. — Corn (guideline) [Ep 3 · 28:11](https://qa.library.globalcastmd.com/watch/inflammatory-bowel-disease-update-course-2014-1042?t=1691)

## Host summaries
Recaps by a host of what the experts said — not the host's own clinical position.
- In a review study published recently, CT enterography is more accurate than MR enterography for Crohn's disease, though institutional radiologist expertise determines which modality performs better in practice. — Samir Pandya summarizing a resource [Ep 1 · 0:00](https://qa.library.globalcastmd.com/watch/inflammatory-bowel-disease-samir-pandya-update-course-2014-655?t=0)
- Contrast-enhanced ultrasound has sensitivity and specificity as high as 100% for Crohn's disease in previously undiagnosed patients, and above 95% in patients with known diagnosis, according to the Peloda study published in Pediatrics 2013. — Samir Pandya summarizing a resource [Ep 1 · 4:00](https://qa.library.globalcastmd.com/watch/inflammatory-bowel-disease-samir-pandya-update-course-2014-655?t=240)
- Contrast-enhanced ultrasound is only available for clinical use in Europe at present and has not been approved by the FDA. — Samir Pandya summarizing a resource [Ep 1 · 4:00](https://qa.library.globalcastmd.com/watch/inflammatory-bowel-disease-samir-pandya-update-course-2014-655?t=240)
- In Europe, ultrasound is the first-line imaging choice for Crohn's disease, followed by MR or CT enterography, whereas in the US, MR/CT enterography is first-line. — Samir Pandya summarizing a resource [Ep 1 · 5:00](https://qa.library.globalcastmd.com/watch/inflammatory-bowel-disease-samir-pandya-update-course-2014-655?t=300)
- MR enterography provides information about the chronicity of Crohn's disease strictures, helping determine whether a stricture is chronic and fibrotic (unlikely to resolve with medication) or potentially responsive to medical therapy. — Samir Pandya summarizing a resource [Ep 1 · 6:00](https://qa.library.globalcastmd.com/watch/inflammatory-bowel-disease-samir-pandya-update-course-2014-655?t=360)
- Rectal advancement flap for Crohn's perianal fistula is only appropriate in the setting of no active proctitis, and results diminish with time. — Samir Pandya summarizing a resource [Ep 1 · 18:00](https://qa.library.globalcastmd.com/watch/inflammatory-bowel-disease-samir-pandya-update-course-2014-655?t=1080)
- Even with permanent fecal diversion, as high as 40% of Crohn's patients have recalcitrant perianal disease as they reach adulthood. — Samir Pandya summarizing a resource [Ep 1 · 20:00](https://qa.library.globalcastmd.com/watch/inflammatory-bowel-disease-samir-pandya-update-course-2014-655?t=1200)
- Isolated ileocecal Crohn's disease in teenagers can have recurrence-free intervals as long as 10 to 15 years after resection, allowing symptom-free passage through puberty into adulthood. — Samir Pandya summarizing a resource [Ep 1 · 22:00](https://qa.library.globalcastmd.com/watch/inflammatory-bowel-disease-samir-pandya-update-course-2014-655?t=1320)
- If a patient has received infliximab within the last 6 weeks before surgery for ulcerative colitis, there is evidence (both adult and pediatric) that a three-stage approach should probably be used due to increased complication risk. — Samir Pandya summarizing a resource [Ep 1 · 28:36](https://qa.library.globalcastmd.com/watch/inflammatory-bowel-disease-samir-pandya-update-course-2014-655?t=1716)
- At 2 years follow-up, there is hardly any difference in bowel frequency between straight ileoanal anastomosis and J-pouch (10 cm J-pouches) for ulcerative colitis, based on a series of 120-130 straight and 110-115 J-pouch patients. — Samir Pandya summarizing a resource [Ep 1 · 28:36](https://qa.library.globalcastmd.com/watch/inflammatory-bowel-disease-samir-pandya-update-course-2014-655?t=1716)
- In the Chinese trial, the early feeding group started feeds at 2 days compared to 6 days in the traditional feeding group — Rod Gerardo summarizing the discussion [Ep 5 · 0:44](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-september-2021-4527?t=44)
- There was no significant difference between early and traditional feeding groups in length of stay, time to full feeds, postoperative complications, 30-day mortality, or 30-day readmissions — Rod Gerardo summarizing the discussion [Ep 5 · 0:44](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-september-2021-4527?t=44)
- In the early feeding group, patients did not have a decompressing nasogastric tube, suggesting nasogastric decompression is not needed after neonatal intestinal anastomosis — Rod Gerardo summarizing the discussion [Ep 5 · 3:06](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-september-2021-4527?t=186)
- The Utah study created a risk score to predict Meckel's diverticulum in patients presenting with hematochezia — Ellen Encisco summarizing the discussion [Ep 5 · 5:10](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-september-2021-4527?t=310)
- Todd Ponsky suggests using the Meckel's score to go straight to laparoscopy in high-score patients, skipping the Meckel scan, because even with a negative scan he would still suspect Meckel's diverticulum — Rod Gerardo summarizing the discussion [Ep 5 · 5:10](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-september-2021-4527?t=310)
- Under the age of 10, workup for Crohn's disease is not needed in children with perianal symptoms; over age 10, workup should be performed — Rod Gerardo summarizing the discussion [Ep 5 · 10:06](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-september-2021-4527?t=606)
- In the adult population, mobilization and early PO intake are the most important drivers to early discharge — Kurt Heise summarizing a resource [Ep 4 · 4:53](https://qa.library.globalcastmd.com/watch/update-course-rewind-2020-eras-3718?t=293)
- Over half of bariatric patients after sleeve gastrectomy can be discharged on the first postoperative day — The host summarizes what Dr. Kurt Heise said [Ep 4 · 5:52](https://qa.library.globalcastmd.com/watch/update-course-rewind-2020-eras-3718?t=352)
- Regional blocks used include QL blocks, rectus sheath blocks, or TAP blocks to allow earlier patient mobilization compared to epidurals — Kurt Heise summarizing a resource [Ep 4 · 6:31](https://qa.library.globalcastmd.com/watch/update-course-rewind-2020-eras-3718?t=391)
- Big surgeries including colectomies and craniofacial reconstructions can be performed without the use of narcotics using premedications and regional blocks — Kurt Heise summarizing a resource [Ep 4 · 7:25](https://qa.library.globalcastmd.com/watch/update-course-rewind-2020-eras-3718?t=445)
- ERAS is a multidisciplinary, multimodal, evidence-based way of delivering care to patients — The host summarizes what Dr. Kurt Heise said [Ep 4 · 8:20](https://qa.library.globalcastmd.com/watch/update-course-rewind-2020-eras-3718?t=500)
- The goals of ERAS are to optimize patient physiology throughout the entire perioperative pathway — The host summarizes what Dr. Kurt Heise said [Ep 4 · 8:40](https://qa.library.globalcastmd.com/watch/update-course-rewind-2020-eras-3718?t=520)
- ERAS strategy aims to decrease operative trauma, inflammatory response, and stress — The host summarizes what Dr. Kurt Heise said [Ep 4 · 8:55](https://qa.library.globalcastmd.com/watch/update-course-rewind-2020-eras-3718?t=535)
- ERAS tactics include optimizing fluid and analgesia, mobilizing early, and feeding early, which work synergistically when bundled — The host summarizes what Dr. Kurt Heise said [Ep 4 · 9:10](https://qa.library.globalcastmd.com/watch/update-course-rewind-2020-eras-3718?t=550)
- ERAS outcomes include faster healing, earlier discharge, and fewer complications of all types, not just surgical complications — The host summarizes what Dr. Kurt Heise said [Ep 4 · 9:30](https://qa.library.globalcastmd.com/watch/update-course-rewind-2020-eras-3718?t=570)
- When ERAS is done well with focus on the full spectrum of care, it should decrease readmission rates — The host summarizes what Dr. Kurt Heise said [Ep 4 · 9:50](https://qa.library.globalcastmd.com/watch/update-course-rewind-2020-eras-3718?t=590)
- Implementation of ERAS elements over time shows decreased intraoperative fluids, decreased intraoperative and postoperative narcotics, and decreased time to full diet — The host summarizes what Dr. Kurt Heise said [Ep 4 · 10:18](https://qa.library.globalcastmd.com/watch/update-course-rewind-2020-eras-3718?t=618)
- In Sweden, 50% of facilities are performing ileorectal anastomosis rather than ileal pouch anal anastomosis for ulcerative colitis due to infertility concerns — The host summarizing the discussion [Ep 2 · 5:57](https://qa.library.globalcastmd.com/watch/inflammatory-bowel-disease-update-course-2015-987?t=357)
- Infertility rates after J-pouch in females can be as high as 60% — The host summarizing the discussion [Ep 2 · 5:57](https://qa.library.globalcastmd.com/watch/inflammatory-bowel-disease-update-course-2015-987?t=357)
- The general infertility rate in the United States is around 10-11% — The host summarizing the discussion [Ep 2 · 5:57](https://qa.library.globalcastmd.com/watch/inflammatory-bowel-disease-update-course-2015-987?t=357)
- Infertility rates after laparoscopic J-pouch procedures are approximately 20-30%, compared to 50-60% for open procedures — The host summarizing the discussion [Ep 2 · 5:57](https://qa.library.globalcastmd.com/watch/inflammatory-bowel-disease-update-course-2015-987?t=357)
- Fecundity (ability to carry a pregnancy) is the same after J-pouch procedures, though patients may need assistance with conception — The host summarizing the discussion [Ep 2 · 5:57](https://qa.library.globalcastmd.com/watch/inflammatory-bowel-disease-update-course-2015-987?t=357)
- In some European practices, performing a pull-through procedure on a patient before the end of their childbearing years would be considered unacceptable or grounds for legal action — The host summarizing the discussion [Ep 2 · 5:57](https://qa.library.globalcastmd.com/watch/inflammatory-bowel-disease-update-course-2015-987?t=357)
- Some surgeons perform total proctocolectomy with J-pouch reconstruction in selected Crohn's patients with good results, as reported in adult literature — The host summarizing the discussion [Ep 2 · 10:48](https://qa.library.globalcastmd.com/watch/inflammatory-bowel-disease-update-course-2015-987?t=648)
- In a review study published recently, CT enterography was shown to be more accurate than MR enterography for Crohn's disease, though institutional radiologist expertise affects which modality performs better. — The host summarizing the discussion [Ep 3 · 0:54](https://qa.library.globalcastmd.com/watch/inflammatory-bowel-disease-update-course-2014-1042?t=54)
- In the Peloda study published in Pediatrics 2013, contrast-enhanced ultrasound showed sensitivity and specificity as high as 100% in previously undiagnosed patients and above 95% in those with known Crohn's diagnosis. — Samir summarizing the discussion [Ep 3 · 2:19](https://qa.library.globalcastmd.com/watch/inflammatory-bowel-disease-update-course-2014-1042?t=139)
- In Europe, ultrasound is the first-line imaging choice for Crohn's disease, followed by MR or CT enterography, whereas in the US, MR/CT enterography is first-line. — Samir summarizing the discussion [Ep 3 · 2:19](https://qa.library.globalcastmd.com/watch/inflammatory-bowel-disease-update-course-2014-1042?t=139)
- Rectal advancement flap for perianal fistula is only recommended in the setting of no active proctitis, and results diminish with time. — Samir summarizing the discussion [Ep 3 · 14:31](https://qa.library.globalcastmd.com/watch/inflammatory-bowel-disease-update-course-2014-1042?t=871)
- Even with permanent diversion, as high as 40% of Crohn's patients develop recalcitrant perianal disease as they reach adulthood. — Samir summarizing the discussion [Ep 3 · 17:27](https://qa.library.globalcastmd.com/watch/inflammatory-bowel-disease-update-course-2014-1042?t=1047)
- In a study of approximately 120-130 straight ileoanal anastomoses and 110-115 J-pouches (10cm J-pouches), at 2 years follow-up there was hardly any difference in bowel frequency between the two techniques. — Samir summarizing the discussion [Ep 3 · 27:28](https://qa.library.globalcastmd.com/watch/inflammatory-bowel-disease-update-course-2014-1042?t=1648)

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