# 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 · 5 episodes · 112 cited statements

## Episodes
### Surgical Management
- [Enhanced Recovery After Surgery (ERAS) Program: Update Course 2016](https://library.globalcastmd.com/watch/enhanced-recovery-after-surgery-program-update-course-2016-913) — video · 44:22 · [machine version](https://library.globalcastmd.com/watch/enhanced-recovery-after-surgery-program-update-course-2016-913.md)
- [Inflammatory Bowel Disease: Update Course 2015](https://library.globalcastmd.com/watch/inflammatory-bowel-disease-update-course-2015-987) — video · 13:49 · [machine version](https://library.globalcastmd.com/watch/inflammatory-bowel-disease-update-course-2015-987.md)

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

## Chapters
- [0:00](https://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://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://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://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://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://library.globalcastmd.com/watch/enhanced-recovery-after-surgery-program-update-course-2016-913?t=0) Introduction to ERAS Concept and Historical Context (Ep 2)
- [7:00](https://library.globalcastmd.com/watch/enhanced-recovery-after-surgery-program-update-course-2016-913?t=420) ERAS Components and Physiologic Rationale (Ep 2)
- [15:00](https://library.globalcastmd.com/watch/enhanced-recovery-after-surgery-program-update-course-2016-913?t=900) Evidence Base: Adult and Pediatric Outcomes (Ep 2)
- [22:00](https://library.globalcastmd.com/watch/enhanced-recovery-after-surgery-program-update-course-2016-913?t=1320) Implementation Strategy and Team Building (Ep 2)
- [30:00](https://library.globalcastmd.com/watch/enhanced-recovery-after-surgery-program-update-course-2016-913?t=1800) Interactive Discussion: Practical Implementation Questions (Ep 2)
- [0:00](https://library.globalcastmd.com/watch/inflammatory-bowel-disease-update-course-2015-987?t=0) Crohn's Disease Case: Timing of Surgery and TNF Inhibitor Management (Ep 3)
- [3:05](https://library.globalcastmd.com/watch/inflammatory-bowel-disease-update-course-2015-987?t=185) Ulcerative Colitis: J-Pouch Reconstruction and Infertility Considerations (Ep 3)
- [8:27](https://library.globalcastmd.com/watch/inflammatory-bowel-disease-update-course-2015-987?t=507) Surveillance Colonoscopy as Alternative to Prophylactic Colectomy (Ep 3)
- [9:38](https://library.globalcastmd.com/watch/inflammatory-bowel-disease-update-course-2015-987?t=578) Indeterminate Colitis: Surgical Approach and J-Pouch Controversy (Ep 3)
- [11:31](https://library.globalcastmd.com/watch/inflammatory-bowel-disease-update-course-2015-987?t=691) Technical Considerations and Volume-Outcome Relationship for J-Pouch (Ep 3)
- [0:00](https://library.globalcastmd.com/watch/inflammatory-bowel-disease-update-course-2014-1042?t=0) Case 1 Introduction: Crohn's with Perianal Abscess - Imaging Modalities (Ep 4)
- [3:47](https://library.globalcastmd.com/watch/inflammatory-bowel-disease-update-course-2014-1042?t=227) Surgical Management of Fistulizing and Fibrostenotic Crohn's Disease (Ep 4)
- [12:45](https://library.globalcastmd.com/watch/inflammatory-bowel-disease-update-course-2014-1042?t=765) Perianal Disease Management and Strictureplasty Indications (Ep 4)
- [18:24](https://library.globalcastmd.com/watch/inflammatory-bowel-disease-update-course-2014-1042?t=1104) Duodenal Crohn's and Isolated Terminal Ileal Disease (Ep 4)
- [20:46](https://library.globalcastmd.com/watch/inflammatory-bowel-disease-update-course-2014-1042?t=1246) Case 2: Severe Ulcerative Colitis - Surgical Approach (Ep 4)
- [0:05](https://library.globalcastmd.com/watch/colorectal-quiz-episode-26-perianal-crohn-s-disease-4890?t=5) Introduction and case presentation setup (Ep 5)
- [1:49](https://library.globalcastmd.com/watch/colorectal-quiz-episode-26-perianal-crohn-s-disease-4890?t=109) Case presentation and diagnostic workup discussion (Ep 5)
- [5:12](https://library.globalcastmd.com/watch/colorectal-quiz-episode-26-perianal-crohn-s-disease-4890?t=312) Imaging workup and biologic risks (Ep 5)
- [7:51](https://library.globalcastmd.com/watch/colorectal-quiz-episode-26-perianal-crohn-s-disease-4890?t=471) Surgical planning and timing (Ep 5)
- [11:21](https://library.globalcastmd.com/watch/colorectal-quiz-episode-26-perianal-crohn-s-disease-4890?t=681) Operative findings and surgical technique (Ep 5)
- [15:22](https://library.globalcastmd.com/watch/colorectal-quiz-episode-26-perianal-crohn-s-disease-4890?t=922) Postoperative course and endoscopic findings (Ep 5)
- [16:46](https://library.globalcastmd.com/watch/colorectal-quiz-episode-26-perianal-crohn-s-disease-4890?t=1006) Biologic therapy timing and seton management (Ep 5)
- [21:52](https://library.globalcastmd.com/watch/colorectal-quiz-episode-26-perianal-crohn-s-disease-4890?t=1312) Summary and closing (Ep 5)

## 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 5 · 9:29](https://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 5 · 9:00](https://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 5 · 12:31](https://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 5 · 13:12](https://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 5 · 6:52](https://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." — Christine Velasco (clinical) [Ep 5 · 6:29](https://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." — Christine Velasco (clinical) [Ep 5 · 3:47](https://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 5 · 4:36](https://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 5 · 17:54](https://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 5 · 19:23](https://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 5 · 19:55](https://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 5 · 20:49](https://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 5 · 20:27](https://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 5 · 19:12](https://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 5 · 17:17](https://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 5 · 17:17](https://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 5 · 14:15](https://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 5 · 14:54](https://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 5 · 18:45](https://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 5 · 7:24](https://library.globalcastmd.com/watch/colorectal-quiz-episode-26-perianal-crohn-s-disease-4890?t=444)
- "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 (host_summary) [Ep 1 · 0:00](https://library.globalcastmd.com/watch/inflammatory-bowel-disease-samir-pandya-update-course-2014-655?t=0)
- "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://library.globalcastmd.com/watch/inflammatory-bowel-disease-samir-pandya-update-course-2014-655?t=180)
- "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 (host_summary) [Ep 1 · 4:00](https://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 (host_summary) [Ep 1 · 4:00](https://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 (host_summary) [Ep 1 · 5:00](https://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 (host_summary) [Ep 1 · 6:00](https://library.globalcastmd.com/watch/inflammatory-bowel-disease-samir-pandya-update-course-2014-655?t=360)
- "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://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://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://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://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://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://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://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://library.globalcastmd.com/watch/inflammatory-bowel-disease-samir-pandya-update-course-2014-655?t=1020)
- "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 (host_summary) [Ep 1 · 18:00](https://library.globalcastmd.com/watch/inflammatory-bowel-disease-samir-pandya-update-course-2014-655?t=1080)
- "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://library.globalcastmd.com/watch/inflammatory-bowel-disease-samir-pandya-update-course-2014-655?t=1140)
- "Even with permanent fecal diversion, as high as 40% of Crohn's patients have recalcitrant perianal disease as they reach adulthood." — Samir Pandya (host_summary) [Ep 1 · 20:00](https://library.globalcastmd.com/watch/inflammatory-bowel-disease-samir-pandya-update-course-2014-655?t=1200)
- "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://library.globalcastmd.com/watch/inflammatory-bowel-disease-samir-pandya-update-course-2014-655?t=1260)
- "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 (host_summary) [Ep 1 · 22:00](https://library.globalcastmd.com/watch/inflammatory-bowel-disease-samir-pandya-update-course-2014-655?t=1320)
- "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://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://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://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://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://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://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://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://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://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://library.globalcastmd.com/watch/inflammatory-bowel-disease-samir-pandya-update-course-2014-655?t=1800)
- "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 (host_summary) [Ep 1 · 28:36](https://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 (host_summary) [Ep 1 · 28:36](https://library.globalcastmd.com/watch/inflammatory-bowel-disease-samir-pandya-update-course-2014-655?t=1716)
- "Henrik Kehlet published results 20 years ago showing open sigmoidectomy patients discharged within a couple of days with multimodal care, achieving rapid return to work without high readmission rates and with very low complication rates." — Matt Kurt (clinical) [Ep 2 · 0:00](https://library.globalcastmd.com/watch/enhanced-recovery-after-surgery-program-update-course-2016-913?t=0)
- "Traditional intraoperative fluid administration delivers 3 times the IV volume compared to enhanced recovery protocols, as demonstrated by studies monitoring fluid administration." — Matt Kurt (host_summary) [Ep 2 · 3:00](https://library.globalcastmd.com/watch/enhanced-recovery-after-surgery-program-update-course-2016-913?t=180)
- "National anesthesia guidelines permit clear carbohydrate liquids until 2 hours before operation, though this is not widely practiced due to concerns about cancellations from patient misunderstanding." — Matt Kurt (guideline) [Ep 2 · 4:00](https://library.globalcastmd.com/watch/enhanced-recovery-after-surgery-program-update-course-2016-913?t=240)
- "The sooner an IV is removed and the patient leaves the hospital, the safer the patient becomes, because as long as humans are administering care in hospitals, patients remain at risk for medication errors involving the five rights (right patient, dose, medicine, mode, timing)." — Matt Kurt (opinion) [Ep 2 · 5:00](https://library.globalcastmd.com/watch/enhanced-recovery-after-surgery-program-update-course-2016-913?t=300)
- "Adult colorectal surgery has a large number of randomized controlled trials demonstrating ERAS reduces complications and length of stay without causing increased readmissions." — Matt Kurt (host_summary) [Ep 2 · 6:00](https://library.globalcastmd.com/watch/enhanced-recovery-after-surgery-program-update-course-2016-913?t=360)
- "Meta-analysis from adult colorectal surgery demonstrates significant decrease in length of stay, significant decrease in non-surgical complications (VTEs, urinary tract infections, surgical site infections), without increase in readmissions when ERAS protocols are used." — Matt Kurt (host_summary) [Ep 2 · 9:00](https://library.globalcastmd.com/watch/enhanced-recovery-after-surgery-program-update-course-2016-913?t=540)
- "Pediatric ERAS literature consists of only 5-6 articles, most written by Ben-Oni Mathai, showing decreased length of stay with similar complication rates and no increase in readmissions, but each study implemented only about 5 of 20 protocol components (approximately 25% compliance)." — Matt Kurt (host_summary) [Ep 2 · 10:30](https://library.globalcastmd.com/watch/enhanced-recovery-after-surgery-program-update-course-2016-913?t=630)
- "Adult ERAS programs implement 17-20 protocol steps, whereas pediatric studies have only implemented about 5 steps, representing a significant implementation gap." — Matt Kurt (clinical) [Ep 2 · 11:30](https://library.globalcastmd.com/watch/enhanced-recovery-after-surgery-program-update-course-2016-913?t=690)
- "Preoperative pain medication cocktail includes gabapentin and acetaminophen in large quantities; adult programs add celecoxib to this regimen." — Matt Kurt (clinical) [Ep 2 · 15:00](https://library.globalcastmd.com/watch/enhanced-recovery-after-surgery-program-update-course-2016-913?t=900)
- "Goal-directed fluid therapy using pressors and albumin helps limit fluid administration; the most important inflection point in MD Anderson's program was preventing residents from bolusing patients postoperatively." — Matt Kurt (host_summary) [Ep 2 · 16:00](https://library.globalcastmd.com/watch/enhanced-recovery-after-surgery-program-update-course-2016-913?t=960)
- "Patients receive high-sugar electrolyte solutions until 2 hours before surgery after stopping solids at midnight, avoiding bringing a dehydrated patient to the operating room." — Matt Kurt (clinical) [Ep 2 · 4:00](https://library.globalcastmd.com/watch/enhanced-recovery-after-surgery-program-update-course-2016-913?t=240)
- "Foley catheters are removed immediately after surgery for ileocecectomy; for J-pouch procedures they are left overnight and removed in the morning, with no urinary retention issues reported." — Matt Kurt (clinical) [Ep 2 · 17:30](https://library.globalcastmd.com/watch/enhanced-recovery-after-surgery-program-update-course-2016-913?t=1050)
- "Patients are fed and given fluids on postoperative day 0; if they drink successfully once, they are advanced to solid food, with the rationale that dexamethasone increases hunger, ondansetron prevents nausea, and avoiding overhydration and narcotics allows the gut to function." — Matt Kurt (clinical) [Ep 2 · 18:30](https://library.globalcastmd.com/watch/enhanced-recovery-after-surgery-program-update-course-2016-913?t=1110)
- "A 17-year-old patient with ulcerative colitis had colectomy and was ready for discharge the night of surgery, actually discharged postoperative day 2; same pattern occurred for J-pouch creation and ileostomy closure." — Matt Kurt (clinical) [Ep 2 · 20:00](https://library.globalcastmd.com/watch/enhanced-recovery-after-surgery-program-update-course-2016-913?t=1200)
- "IBD patients on TPN, steroids, and other medications do not go home in 2 days but will go home in 3-4 days with ERAS protocol, compared to longer traditional stays." — Matt Kurt (clinical) [Ep 2 · 21:00](https://library.globalcastmd.com/watch/enhanced-recovery-after-surgery-program-update-course-2016-913?t=1260)
- "Individual ERAS components may not have significant evidence bases by themselves, but when bundled together like other care bundles, they create a second-order change in outcomes." — Matt Kurt (opinion) [Ep 2 · 22:00](https://library.globalcastmd.com/watch/enhanced-recovery-after-surgery-program-update-course-2016-913?t=1320)
- "Creating a formal multidisciplinary team (anesthesia, perioperative nursing, floor nursing, nurse clinician) dramatically improved protocol compliance; before team formalization, 5-8 components were achieved, afterward compliance increased substantially." — Matt Kurt (clinical) [Ep 2 · 24:00](https://library.globalcastmd.com/watch/enhanced-recovery-after-surgery-program-update-course-2016-913?t=1440)
- "Monthly team meetings review compliance for each individual patient, identify upcoming cases, discuss needed improvements, and provide ongoing education; this audit process is critical to program success." — Matt Kurt (clinical) [Ep 2 · 25:00](https://library.globalcastmd.com/watch/enhanced-recovery-after-surgery-program-update-course-2016-913?t=1500)
- "Anesthesiologists view ERAS as part of their future through the 'surgical home' concept, making them natural partners in implementation." — Matt Kurt (opinion) [Ep 2 · 26:00](https://library.globalcastmd.com/watch/enhanced-recovery-after-surgery-program-update-course-2016-913?t=1560)
- "Engaging partners through data demonstration rather than just advocacy is more effective; showing improved outcomes leads to adoption, whereas simply talking about the protocol has different results." — Matt Kurt (opinion) [Ep 2 · 27:00](https://library.globalcastmd.com/watch/enhanced-recovery-after-surgery-program-update-course-2016-913?t=1620)
- "Gabapentin is an anti-seizure medication that influences neurologic pain and works well as part of multimodal analgesia; pediatric dosing is 10 mg/kg." — Matt Kurt (clinical) [Ep 2 · 30:00](https://library.globalcastmd.com/watch/enhanced-recovery-after-surgery-program-update-course-2016-913?t=1800)
- "IV lidocaine given intraoperatively attenuates the inflammatory response to surgical wounding, helping patients recover more quickly; this is used in some adult programs." — Matt Kurt (clinical) [Ep 2 · 31:00](https://library.globalcastmd.com/watch/enhanced-recovery-after-surgery-program-update-course-2016-913?t=1860)
- "The most recent literature on mechanical bowel preparation suggests that combining both mechanical prep and oral antibiotics provides the best outcomes, though this recommendation has changed yearly." — Matt Kurt (host_summary) [Ep 2 · 35:00](https://library.globalcastmd.com/watch/enhanced-recovery-after-surgery-program-update-course-2016-913?t=2100)
- "Chewing gum given to school-aged patients generates saliva that goes down the GI tract, stimulating bowel function and gas passage; this is a cheap addition to the protocol." — Matt Kurt (clinical) [Ep 2 · 37:00](https://library.globalcastmd.com/watch/enhanced-recovery-after-surgery-program-update-course-2016-913?t=2220)
- "When patients develop complications such as bowel obstruction or anastomotic leak, they come off the ERAS protocol and are treated as traditional patients; this occurred in approximately 10% of cases in the speaker's series." — Matt Kurt (clinical) [Ep 2 · 39:00](https://library.globalcastmd.com/watch/enhanced-recovery-after-surgery-program-update-course-2016-913?t=2340)
- "Sleeve gastrectomy patients implementing ERAS components, particularly gabapentin, have gone home on postoperative day 1 in all but one case, compared to previous average of closer to 2 days." — Matt Kurt (host_summary) [Ep 2 · 41:00](https://library.globalcastmd.com/watch/enhanced-recovery-after-surgery-program-update-course-2016-913?t=2460)
- "A Journal of Pediatric Surgery study showed that 70% of patients are NPO longer than necessary when coming to the operating room, arriving dehydrated despite standard NPO guidelines." — Matt Kurt (host_summary) [Ep 2 · 34:00](https://library.globalcastmd.com/watch/enhanced-recovery-after-surgery-program-update-course-2016-913?t=2040)
- "NG tubes prolong ileus because they suction out material that would otherwise go downstream and stimulate bowel function." — Matt Kurt (clinical) [Ep 2 · 43:00](https://library.globalcastmd.com/watch/enhanced-recovery-after-surgery-program-update-course-2016-913?t=2580)
- "Gawande's checklist manifesto demonstrated that a 30% compliance rate with a protocol dropped mortality in half, suggesting that partial ERAS compliance still provides benefit." — Matt Kurt (host_summary) [Ep 2 · 40:00](https://library.globalcastmd.com/watch/enhanced-recovery-after-surgery-program-update-course-2016-913?t=2400)
- "Patient and family education with goal sheets may be on equal footing with physiologic interventions in terms of impact, as empowering patients and giving them control over their care drives compliance and outcomes." — Matt Kurt (opinion) [Ep 2 · 22:30](https://library.globalcastmd.com/watch/enhanced-recovery-after-surgery-program-update-course-2016-913?t=1350)
- "For Crohn's disease with terminal ileum stricture and phlegmonous changes encasing the ureter, laparoscopic ileocystectomy with a lighted ureteral stent for ureter identification is the appropriate surgical approach." (clinical) [Ep 3 · 1:05](https://library.globalcastmd.com/watch/inflammatory-bowel-disease-update-course-2015-987?t=65)
- "If the patient is stable, giving a couple weeks of antibiotics to cool down inflammation before surgery is advisable in Crohn's disease." (clinical) [Ep 3 · 1:26](https://library.globalcastmd.com/watch/inflammatory-bowel-disease-update-course-2015-987?t=86)
- "There is no data to support the exact timing of preoperative antibiotics in Crohn's disease." (clinical) [Ep 3 · 1:35](https://library.globalcastmd.com/watch/inflammatory-bowel-disease-update-course-2015-987?t=95)
- "Based on small literature, surgery should be delayed 2-4 weeks from the last TNF inhibitor infusion preoperatively if possible." (clinical) [Ep 3 · 1:38](https://library.globalcastmd.com/watch/inflammatory-bowel-disease-update-course-2015-987?t=98)
- "Postoperatively, TNF inhibitor can be restarted after about 2 weeks if active disease is seen in other parts of the bowel, or after 4 weeks if disease is less aggressive." (clinical) [Ep 3 · 1:38](https://library.globalcastmd.com/watch/inflammatory-bowel-disease-update-course-2015-987?t=98)
- "The literature on anastomotic complications with TNF inhibitors is mixed; wound complications are the biggest concern in the literature." (clinical) [Ep 3 · 2:34](https://library.globalcastmd.com/watch/inflammatory-bowel-disease-update-course-2015-987?t=154)
- "The decision to perform single-stage versus diverted J-pouch reconstruction depends on intraoperative findings including ease of pouch creation, tissue health, and presence of tension." (clinical) [Ep 3 · 3:59](https://library.globalcastmd.com/watch/inflammatory-bowel-disease-update-course-2015-987?t=239)
- "Patients on steroids and infliximab have risk factors for anastomotic complications." (clinical) [Ep 3 · 3:59](https://library.globalcastmd.com/watch/inflammatory-bowel-disease-update-course-2015-987?t=239)
- "Surgery for ulcerative colitis may be indicated when complications of medical therapy (long-term side effects of anti-TNF drugs, steroids, growth failure) become intolerable, even if the disease is controlled." (clinical) [Ep 3 · 4:38](https://library.globalcastmd.com/watch/inflammatory-bowel-disease-update-course-2015-987?t=278)
- "In Sweden, 50% of facilities are doing ileorectal anastomosis instead of ileal pouch-anal anastomosis due to concerns about infertility in females." (host_summary) [Ep 3 · 5:57](https://library.globalcastmd.com/watch/inflammatory-bowel-disease-update-course-2015-987?t=357)
- "Infertility rates after J-pouch are as high as 60% in some series." (host_summary) [Ep 3 · 5:59](https://library.globalcastmd.com/watch/inflammatory-bowel-disease-update-course-2015-987?t=359)
- "The infertility rate in the United States general population is around 10-11%." (host_summary) [Ep 3 · 5:59](https://library.globalcastmd.com/watch/inflammatory-bowel-disease-update-course-2015-987?t=359)
- "Infertility rate after laparoscopic J-pouch procedures is about 20-30%, compared to 50-60% with open procedures." (host_summary) [Ep 3 · 5:59](https://library.globalcastmd.com/watch/inflammatory-bowel-disease-update-course-2015-987?t=359)
- "Fecundity rate (ability to carry a pregnancy) is the same after J-pouch; patients may need assistance with conception but can carry pregnancies." (host_summary) [Ep 3 · 5:59](https://library.globalcastmd.com/watch/inflammatory-bowel-disease-update-course-2015-987?t=359)
- "In some European practices, performing a pull-through operation on a patient before the end of their childbearing years is considered unacceptable." (host_summary) [Ep 3 · 5:59](https://library.globalcastmd.com/watch/inflammatory-bowel-disease-update-course-2015-987?t=359)
- "It is no longer necessarily true that the colon must be removed in all ulcerative colitis patients; surveillance colonoscopy is an acceptable alternative." (host_summary) [Ep 3 · 8:02](https://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 3 · 8:27](https://library.globalcastmd.com/watch/inflammatory-bowel-disease-update-course-2015-987?t=507)
- "Patients with ulcerative colitis can live their entire life with their colons if they undergo yearly surveillance colonoscopy; there is no reason to have a colectomy without other indications beyond cancer risk alone." (clinical) [Ep 3 · 8:27](https://library.globalcastmd.com/watch/inflammatory-bowel-disease-update-course-2015-987?t=507)
- "For indeterminate colitis with patchy disease throughout the colon, the conservative approach is to divert with ileostomy and observe what happens to the colon." (clinical) [Ep 3 · 9:38](https://library.globalcastmd.com/watch/inflammatory-bowel-disease-update-course-2015-987?t=578)
- "For indeterminate colitis with extensively diseased colon, one would consider subtotal colectomy with ileostomy to obtain a large specimen for pathologic determination of disease type." (clinical) [Ep 3 · 9:38](https://library.globalcastmd.com/watch/inflammatory-bowel-disease-update-course-2015-987?t=578)
- "There is literature on doing total proctocolectomy and J-pouch for indeterminate colitis, but it carries more risk." (clinical) [Ep 3 · 9:38](https://library.globalcastmd.com/watch/inflammatory-bowel-disease-update-course-2015-987?t=578)
- "Performing a J-pouch in a patient who turns out to have Crohn's disease creates significant challenges." (clinical) [Ep 3 · 10:35](https://library.globalcastmd.com/watch/inflammatory-bowel-disease-update-course-2015-987?t=635)
- "Some surgeons perform total proctocolectomy with J-pouch reconstruction in selected Crohn's patients with good results, as presented in adult literature." (host_summary) [Ep 3 · 10:48](https://library.globalcastmd.com/watch/inflammatory-bowel-disease-update-course-2015-987?t=648)
- "Thin asthenic females with indeterminate colitis do not do well with J-pouch." (clinical) [Ep 3 · 10:57](https://library.globalcastmd.com/watch/inflammatory-bowel-disease-update-course-2015-987?t=657)
- "A stepwise approach to J-pouch in indeterminate colitis allows time to obtain more diagnostic information between stages." (clinical) [Ep 3 · 11:09](https://library.globalcastmd.com/watch/inflammatory-bowel-disease-update-course-2015-987?t=669)
- "J-pouch is a procedure with a definite learning curve in terms of technical aspects." (opinion) [Ep 3 · 11:31](https://library.globalcastmd.com/watch/inflammatory-bowel-disease-update-course-2015-987?t=691)
- "In pediatric patients, the rectum can be divided laparoscopically, everted or stapled across at the columns, then the J-pouch created externally with anvil placement for EEA anastomosis, as an alternative to the adult technique." (clinical) [Ep 3 · 11:58](https://library.globalcastmd.com/watch/inflammatory-bowel-disease-update-course-2015-987?t=718)
- "J-pouch provides the best operation for control of bowel issues in ulcerative colitis patients, and patients can still carry pregnancies even if natural conception is impaired." (opinion) [Ep 3 · 12:58](https://library.globalcastmd.com/watch/inflammatory-bowel-disease-update-course-2015-987?t=778)
- "CT enterography may be more accurate than MR enterography according to a recent review study, though institutional radiologist expertise determines which modality performs better locally." (host_summary) [Ep 4 · 0:54](https://library.globalcastmd.com/watch/inflammatory-bowel-disease-update-course-2014-1042?t=54)
- "Children presenting with Crohn's disease and perianal/perirectal abscess often have non-colonic small intestinal disease." (clinical) [Ep 4 · 1:23](https://library.globalcastmd.com/watch/inflammatory-bowel-disease-update-course-2014-1042?t=83)
- "Contrast-enhanced ultrasound in Europe has sensitivity and specificity as high as 100% for Crohn's disease in previously undiagnosed patients, and above 95% in those with known diagnosis, according to a 2013 Peloda study in Pediatrics." (host_summary) [Ep 4 · 2:19](https://library.globalcastmd.com/watch/inflammatory-bowel-disease-update-course-2014-1042?t=139)
- "MR enterography provides information about both stricture anatomy and chronicity of disease, helping determine whether a stricture is chronic/fibrotic (unlikely to resolve with medication) or potentially responsive to medical therapy." (clinical) [Ep 4 · 3:51](https://library.globalcastmd.com/watch/inflammatory-bowel-disease-update-course-2014-1042?t=231)
- "For a patient with 18-pound weight loss over 4 months and dilated bowel proximal to an 8 cm terminal ileal stricture, these are indications for ileal resection." (clinical) [Ep 4 · 6:42](https://library.globalcastmd.com/watch/inflammatory-bowel-disease-update-course-2014-1042?t=402)
- "Perianal abscesses in Crohn's disease may not heal without temporary diversion, even after resection of gross bowel disease." (opinion) [Ep 4 · 7:50](https://library.globalcastmd.com/watch/inflammatory-bowel-disease-update-course-2014-1042?t=470)
- "For first-time perianal abscess in Crohn's disease, temporary diversion should be considered via laparoscopic ileal resection with end ileostomy and mucous fistula, with stoma closure planned at 3-6 months." (opinion) [Ep 4 · 8:42](https://library.globalcastmd.com/watch/inflammatory-bowel-disease-update-course-2014-1042?t=522)
- "Diversion is typically reserved for patients with distal colon disease as part of perianal disease, not for isolated small bowel Crohn's with perianal abscess." (opinion) [Ep 4 · 9:11](https://library.globalcastmd.com/watch/inflammatory-bowel-disease-update-course-2014-1042?t=551)
- "Bowel continuity slows healing of perianal abscesses in Crohn's disease." (clinical) [Ep 4 · 9:24](https://library.globalcastmd.com/watch/inflammatory-bowel-disease-update-course-2014-1042?t=564)
- "Patients and parents would rather deal with a chronic perianal problem than a stoma, unless there is extensive distal colonic disease." (opinion) [Ep 4 · 9:52](https://library.globalcastmd.com/watch/inflammatory-bowel-disease-update-course-2014-1042?t=592)
- "Setons are very effective for perianal Crohn's disease and are used frequently by colorectal surgeons but rarely by pediatric surgeons, who should use them more often." (opinion) [Ep 4 · 10:40](https://library.globalcastmd.com/watch/inflammatory-bowel-disease-update-course-2014-1042?t=640)
- "When draining a perianal abscess in Crohn's disease, there are usually several fistulas present, not just a single one." (clinical) [Ep 4 · 11:07](https://library.globalcastmd.com/watch/inflammatory-bowel-disease-update-course-2014-1042?t=667)
- "If resection with primary anastomosis and seton placement fails to heal perianal disease, a subsequent laparoscopic diversion can be performed with low morbidity." — Dan (clinical) [Ep 4 · 12:02](https://library.globalcastmd.com/watch/inflammatory-bowel-disease-update-course-2014-1042?t=722)
- "Rectal advancement flap is an option for fistula closure after seton drainage, but only in the setting of no active proctitis." (clinical) [Ep 4 · 12:36](https://library.globalcastmd.com/watch/inflammatory-bowel-disease-update-course-2014-1042?t=756)
- "Peristomal complications are unique to Crohn's patients, including fistulas around the stoma." (host_summary) [Ep 4 · 12:45](https://library.globalcastmd.com/watch/inflammatory-bowel-disease-update-course-2014-1042?t=765)
- "Crohn's disease affects the entire GI tract, though one particular segment may be strictured at a given time." (host_summary) [Ep 4 · 13:11](https://library.globalcastmd.com/watch/inflammatory-bowel-disease-update-course-2014-1042?t=791)
- "Current adult literature recommendations for perianal Crohn's include non-cutting setons, with Remicade exposure ranging from 25-100% of patients." (host_summary) [Ep 4 · 14:31](https://library.globalcastmd.com/watch/inflammatory-bowel-disease-update-course-2014-1042?t=871)
- "Endorectal advancement flap results for perianal fistulas diminish with time." (host_summary) [Ep 4 · 15:16](https://library.globalcastmd.com/watch/inflammatory-bowel-disease-update-course-2014-1042?t=916)
- "A non-cutting seton can be progressively tightened by adding silk sutures to make the loop smaller as it erodes through tissue, without causing pain to the patient." (clinical) [Ep 4 · 15:57](https://library.globalcastmd.com/watch/inflammatory-bowel-disease-update-course-2014-1042?t=957)
- "A cutting seton requires 360-degree tension on tissue to actually cut through; progressive tightening without tension is a non-cutting seton technique." (clinical) [Ep 4 · 16:47](https://library.globalcastmd.com/watch/inflammatory-bowel-disease-update-course-2014-1042?t=1007)
- "Even with permanent diversion, as high as 40% of Crohn's patients have recalcitrant perianal disease as they reach adulthood." (host_summary) [Ep 4 · 17:27](https://library.globalcastmd.com/watch/inflammatory-bowel-disease-update-course-2014-1042?t=1047)
- "For duodenal Crohn's stricture, management with Remicade combined with endoscopic and fluoroscopic dilation can be effective, with stricture becoming more pliable after 3 cycles of Remicade." (clinical) [Ep 4 · 18:30](https://library.globalcastmd.com/watch/inflammatory-bowel-disease-update-course-2014-1042?t=1110)
- "Isolated ileocecal Crohn's disease in teenagers may have recurrence-free intervals as long as 10-15 years after resection, allowing symptom-free passage through puberty into adulthood." (clinical) [Ep 4 · 19:20](https://library.globalcastmd.com/watch/inflammatory-bowel-disease-update-course-2014-1042?t=1160)
- "Isolated terminal ileal disease may be a separate disease entity from perianal or diffuse Crohn's disease, as it behaves very differently." (opinion) [Ep 4 · 20:04](https://library.globalcastmd.com/watch/inflammatory-bowel-disease-update-course-2014-1042?t=1204)
- "For isolated terminal ileal Crohn's disease, early resection before starting Remicade may be a reasonable approach, as these patients do well and can go through teenage years and growth phase successfully." (opinion) [Ep 4 · 20:29](https://library.globalcastmd.com/watch/inflammatory-bowel-disease-update-course-2014-1042?t=1229)
- "In Europe, ultrasound is generally advocated for basically everything, and it is increasingly used in sophisticated pediatric radiology departments for chronic inflammatory bowel disease, though MRI remains the standard diagnostic tool." — Philip (clinical) [Ep 4 · 21:01](https://library.globalcastmd.com/watch/inflammatory-bowel-disease-update-course-2014-1042?t=1261)
- "For a patient with ulcerative colitis in reasonably good nutrition, subtotal colectomy with pull-through and either J-pouch or straight anastomosis with loop ileostomy (closed at 6 weeks to 2 months) is appropriate." (clinical) [Ep 4 · 23:01](https://library.globalcastmd.com/watch/inflammatory-bowel-disease-update-course-2014-1042?t=1381)
- "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 too long, resulting in emaciation, low albumin, poor nutritional status, and prolonged steroid exposure." (opinion) [Ep 4 · 23:37](https://library.globalcastmd.com/watch/inflammatory-bowel-disease-update-course-2014-1042?t=1417)
- "For sick ulcerative colitis patients, a three-stage approach is used: subtotal colectomy with end ileostomy, followed by subsequent J-pouch creation." (clinical) [Ep 4 · 24:29](https://library.globalcastmd.com/watch/inflammatory-bowel-disease-update-course-2014-1042?t=1469)
- "Patients with ulcerative colitis recover incredibly fast after subtotal colectomy, much faster than after subsequent J-pouch creation, and often look their best when they have their stoma." (clinical) [Ep 4 · 24:29](https://library.globalcastmd.com/watch/inflammatory-bowel-disease-update-course-2014-1042?t=1469)
- "Ongoing rectal bleeding from the rectal stump after subtotal colectomy can occur but is rare and can be managed with local therapy." (clinical) [Ep 4 · 24:47](https://library.globalcastmd.com/watch/inflammatory-bowel-disease-update-course-2014-1042?t=1487)
- "Even in relatively sick ulcerative colitis patients, endorectal pull-through can be performed safely using an endorectal technique similar to Hirschsprung surgery, as long as it is backed up with an ileostomy." (clinical) [Ep 4 · 25:00](https://library.globalcastmd.com/watch/inflammatory-bowel-disease-update-course-2014-1042?t=1500)
- "A 3-year-old with severe ulcerative colitis (one of the youngest cases seen) had rectum that felt like tissue paper but was successfully treated with endorectal pull-through and J-pouch, with the child blossoming afterward." (clinical) [Ep 4 · 25:48](https://library.globalcastmd.com/watch/inflammatory-bowel-disease-update-course-2014-1042?t=1548)
- "Continued bleeding from the rectal stump after subtotal colectomy can force earlier-than-anticipated completion of pull-through, occurring more frequently than realized." (clinical) [Ep 4 · 25:48](https://library.globalcastmd.com/watch/inflammatory-bowel-disease-update-course-2014-1042?t=1548)
- "One problem with three-stage ulcerative colitis surgery is that patients often gain 20-30 pounds between stage 1 and 2, making the subsequent operation harder." (clinical) [Ep 4 · 26:17](https://library.globalcastmd.com/watch/inflammatory-bowel-disease-update-course-2014-1042?t=1577)
- "Double-staple technique for ileal pouch-anal anastomosis can be performed by everting the rectum and stapling at the top of the columns, requiring a 21mm stapler." (clinical) [Ep 4 · 26:38](https://library.globalcastmd.com/watch/inflammatory-bowel-disease-update-course-2014-1042?t=1598)
- "A study of approximately 120-130 straight ileal-anal anastomoses and 110-115 J-pouches (10 cm pouches) showed hardly any difference in bowel frequency at 2 years." (host_summary) [Ep 4 · 27:28](https://library.globalcastmd.com/watch/inflammatory-bowel-disease-update-course-2014-1042?t=1648)
- "If a patient has received infliximab within the last 6 weeks, there is evidence (both adult and pediatric) that a three-stage procedure should probably be performed due to increased complication risk." (guideline) [Ep 4 · 28:11](https://library.globalcastmd.com/watch/inflammatory-bowel-disease-update-course-2014-1042?t=1691)

## Changelog
- Sep 16: Published again automatically — condition is back above threshold
- Sep 16: 4 items added automatically
- Sep 16: 7 items no longer name Crohn's disease
- Sep 7: Unpublished automatically — folded or below threshold
- Sep 7: 1 item added automatically
- Sep 7: 7 items added automatically

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