Consultant Gastroenterologist @NHSGGC. @NHSResearchScot research fellow. Associate editor hepatology and endoscopy @FrontGastro_BMJ.
Joined June 2019
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@BritSocGastro update on portal hypertension guidance. 2015 guideline out of date but UK RCT results are pending. In the meantime time, we have written this update based on AASLD guidance with important caveats reflecting UK best practice and more recent data.
🟠 Portal hypertension: beyond varices
New in Frontline Gastroenterology (Open Access): The BSG position statement supports interim use of AASLD guidance — with important UK caveats.
📍 Focus on clinically significant portal hypertension
📊 Use VCTE + platelets to risk stratify
✅ Carvedilol preferred where appropriate
🩺 Endoscopy still matters in the “grey zone”
⚠️ Individualise decisions around NSBB tolerance and contraindications
A timely update while UK trial data are awaited.
🔗 fg.bmj.com/content/early/202…
#FrontlineGastroenterology #Hepatology #Cirrhosis #PortalHypertension #LiverTwitter
Fantastic co-author group: @DunnePdj @DTrip2015 @DrVishalCPatel @jamesbmaurice @drmarkmcphail @lynseycorless @IanARowe @EwanForrest1 @AdrianStanleyGI
@basl_events @heppharm @livernursing @LiverAHPs @Liver4Lifeuk @f4liverresearch @IQILS_Liver @LiverTrust @EASLedu @EASLnews @BritSocGastro @BavenoCoop @BCLC_group @ILCAnews @APASLnews @liverfellow @my_ueg @UKCPAGastro
@PhilSmithIsBack @OTavabie @dr_aditi_kumar @TrevorTabone @eathar_s @IrenePerezMD @KGananandan @zare_benjamin @medicalreg @dtleiberman @BSGtrainees @drkeithsiau @ebtapper @DrLChina @acv69cardenas @GeriKeane @ClinicLiver
Philip Dunne retweeted
Another awesome paper, the second part of the series on Hepatic encephalopathy by @vtkronsten @DebbieShawcros1 et al @BASLedu @BSGTrainees @BritSocGastro #BASL2025
🚨 Hepatic Encephalopathy on the ward? Here’s your roadmap.
Inpatient management of hepatic encephalopathy just dropped in Frontline Gastroenterology:
✅ ACLF
✅ ALF
✅ ICU thresholds
✅ LOLA, lactulose, rifaximin
✅ Transplant triggers
🔓 fg.bmj.com/content/early/202…
#LiverTwitter #GIhepatology
@basl_events @heppharm @livernursing @LiverAHPs @Liver4Lifeuk @f4liverresearch @IQILS_Liver @LiverTrust @EASLedu @EASLnews @BritSocGastro @BavenoCoop @BCLC_group @ILCAnews @APASLnews @liverfellow @my_ueg @UKCPAGastro
@PhilSmithIsBack @OTavabie @dr_aditi_kumar @TrevorTabone @eathar_s @IrenePerezMD @KGananandan @zare_benjamin @medicalreg @dtleiberman @BSGtrainees @drkeithsiau @ebtapper @DrLChina @acv69cardenas @GeriKeane @jamesbmaurice @ClinicLiver @ClinicLiver
Philip Dunne retweeted
👩⚕️👨⚕️ Still avoiding ERCP training due to radiation fears?
🛑 Let’s bust the myths.
📚 Stringer et al lay out the facts, risks & practical mitigations to promote safety, equity, and confidence.
💡 Guidance on PPE, pregnancy, ergonomics, and exposure monitoring.
🔗 doi.org/10.1136/flgastro-202…
#WomenInGI #ERCP #RadiationSafety #Endoscopy #GastroTwitter
@PhilSmithIsBack @OTavabie @dr_aditi_kumar @TrevorTabone @eathar_s @IrenePerezMD @KGananandan @zare_benjamin @medicalreg @dtleiberman @BASLedu @BSGtrainees @WorldGastroOrg @ulstergastro @SEEDendoscopia @EASLedu @AmCollegeGastro @Aegastro @SAGES_updates @UHSEndoscopy @WAGE_media @ESGE_news @my_ueg
Philip Dunne retweeted
Hepatocellular carcinoma surveillance: minimum standards fg.bmj.com/content/early/202…
Philip Dunne retweeted
Calling all ERCP endoscopists! Check out this paper on the use of Needle knife fistulotomy (NKF) in the setting of difficult cannulation, published in the journal.
✅ NKF is an effective method for achieving biliary cannulation in difficult cases on initial attempt (88.5%) and repeat attempt (92.7%), with low risks of pancreatitis (2.4%), bleeding (0.3%) and perforation (0.3%).
📈 Factors associated with higher success and lower complications included ERCP performed for stone disease and Haraldsson type 3 papillae.
⚠️ NKF should be considered early in ERCP where there is difficulty in achieving biliary cannulation, especially where there are favourable characteristics.
fg.bmj.com/content/early/202…
With thanks to the authors: Wai Liam Lam (@bluewailiam), Michael Ding, Chia Chuin Yau, Roderik Prawiradiradja and Srisha Hebbar (@Srisha_Hebbar).
@PhilSmithIsBack @OTavabie @dr_aditi_kumar @DrJMKennedy @DunnePdj @TrevorTabone @eathar_s @IrenePerezMD @KGananandan @zare_benjamin @medicalreg @dtleiberman @drkeithsiau @DrOmerAhmad @Dunnepdj @shraddha_gulati @CardiffGastro @DrBuHayee @poodocnisha @Sharm_Sub
#ERCP #BiliaryEndoscopy #Pancreatobiliary #HPB #BileDuct #Sphincterotomy #TherapeuticEndoscopy #AdvancedEndoscopy #GIEndoscopy #EndoTwitter
Philip Dunne retweeted
🚨 Characteristics, aetiology and outcomes in patients with and without HCC 🚨
Insights from 🏴☠️ @AdrianStanleyGI in @FrontGastro_BMJ —
🔹 21.6% of HCC patients had no cirrhosis - diagnosed older & with more advanced disease.
🔹 No survival difference between cirrhotic & non-cirrhotic patients, but TACE outcomes were better for non-cirrhotic.
Full paper here – fg.bmj.com/content/15/5/380
#HCC #Cirrhosis #LiverCancer #MedicalResearch #CancerCare #Hepatology
@BASLedu @BritSocGastro @EASLnews @EASLedu @AASLDtweets @PhilSmithIsBack @dr_aditi_kumar @OTavabie @DrJMKennedy @DunnePdj @TrevorTabone @eathar_s @IrenePerezMD @KGananandan @zare_benjamin @medicalreg @dtleiberman
Philip Dunne retweeted
Just out! Important #onlinefirst #openaccess #originalresearch from @NeilRajJ1 @NadirAbbas_X @DasariVm and colleagues on liver transplant assessment for HCC:
fg.bmj.com/content/early/202…
Insights into factors affecting listing, five year survival and downstaging pathway.
#livertwitter @sheiybani @PhilSmithIsBack @DrJMKennedy @DunnePdj @TrevorTabone @eathar_s @IrenePerezMD @KGananandan @zare_benjamin @medicalreg @dtleiberman
Philip Dunne retweeted
We are delighted to announce that Frontline Gastroenterology (FG) is now the official journal partner of the British Association for Study of Liver Disease (BASL, @basl_events)
Our Editor in chief @PhilSmithIsBack is pictured with BASL President Dr Tim Cross @ClinicLiver to mark the official affiliation
Read the full statements here via:
bit.ly/3Wi9Ksl
bit.ly/3Ceeqso
#LiverDisease @BAPENUK @BSPGHAN @BritSocGastro @acv69cardenas @DrLChina @GeriKeane @jamesbmaurice @drobeirne @NEndoscopy @DunnePdj @sheiybani @Gut_BMJ @BMJOpen_Gastro @BASLedu
3 year f-u data from our pTIPSS RCT. Reduced 3-year survival in pTIPSS arm with assoc higher rates of sepsis events. Unclear if TIPSS causing (GI blood bypassing Kuppfer cells of liver), carvedilol preventing, or both. Needs further study, pt selection for pTIPSS critical
Long term follow up of patients from an RCT of standard of care vs pre-emptive TIPSS following acute variceal UGIB showed ⬇️ 3 year transplant-free survival.
👉 bit.ly/40xh1Hv 👈
Read our latest #onlinefirst article from @DunnePdj @AdrianStanleyGI @shamsaman @EwanForrest1 and colleagues.
#livertwitter @PhilSmithIsBack @sheiybani @VivekGoodoory @RexWHHui @DrJMKennedy @OTavabie @dr_aditi_kumar
Philip Dunne retweeted
🎉 Happy New Year from all at FG!
Kick off your 2025 with a resolution to keep up to date with all our #onlinefirst content at fg.bmj.com/content/early/rec…
@PhilSmithIsBack @sheiybani
@VivekGoodoory @DunnePdj @RexWHHui @OTavabie @dr_aditi_kumar
Philip Dunne retweeted
Want to become a reviewer for FG?
Register your interest HERE 👉 bit.ly/3AuU8Ky
Why review for us?
✅ Stay up to date
✅ Help contribute to your field
✅ Improve your own editing and writing skills
And much more!
@sheiybani @VivekGoodoory @RexWHHui @DunnePdj @DrJMKennedy @OTavabie @dr_aditi_kumar @PhilSmithIsBack
No surprises here from the home of GMAWS. Patients with alcohol withdrawal syndrome and ArLD are managed extremely well. This paper in @FrontGastro_BMJ is very informative.
fg.bmj.com/content/early/202…
🔍 Latest original research from @EwanForrest1 and colleagues on the management of alcohol withdrawal syndrome (AWS) in patients with advanced alcohol-related liver disease (ArLD)
💡 Patients with AWS but without ArLD received greater doses of benzodiazepines than those with ArLD
💡 AWS with ArLD did not appear to confer poorer survival than ArLD without AWS
💡 Symptom triggered approach with lorazepam effective in AWS and ArLD
@sheiybani @VivekGoodoory @RexWHHui @DunnePdj @DrJMKennedy @OTavabie @dr_aditi_kumar @PhilSmithIsBack
I sit on a NET MDT and found this quite useful
All the need-to-know aspects of diagnosing and staging NETs found at endoscopy from @gastrolivuni, @DrMohidKhan and colleagues, #onlinefirst in FG: bit.ly/3zhUrYE
@sheiybani @VivekGoodoory @RexWHHui @DunnePdj @DrJMKennedy @OTavabie @dr_aditi_kumar @PhilSmithIsBack
Philip Dunne retweeted
#FGImage from the paper by Everett et al:
"British Society of Gastroenterology Endoscopic Retrograde Cholangiopancreatography (ERCP) Quality Improvement Programme: minimum service standards and good practice statements"
bit.ly/3BTrxi5
@SimonMEverett
Philip Dunne retweeted
Congratulations to Prof Ewan Forrest, Consultant Physician and Hepatologist at Glasgow Royal Infirmary, NHS GGC, and Honorary Professor at University of Glasgow, who is the new BSG Alcohol Lead!
Prof Forrest will act as the lead and champion for the BSG on Alcohol, Alcohol-related harm and Alcohol-related liver disease 👉 bit.ly/3NtPD5S
What a pleasure!
I am delighted to introduce the full @FrontGastro_BMJ team from across the globe - see the editorial board here:
fg.bmj.com/pages/editorial-b…
Please submit your research papers & reviews via the website & contact us with any ideas or suggestions:
fg.bmj.com/
#TeamFG
Our letter published in @Gut_BMJ regarding combination NSBBs and banding for primary prophylaxis variceal bleeding. Follows CAVARLY trial. Some interesting findings need confirmed.
gut.bmj.com/content/gutjnl/e…
@AdrianStanleyGI
@EwanForrest1
Guidance from BSG (published in @FrontGastro_BMJ) on minimum standards for running a safe and effective ERCP service. A must read for any ERCPist and should be a helpful document for initiating local audits and discussion with team leads / management to improve practice
Minimum service standards and good practice statements for #ERCP for the @BritSocGastro by @SimonMEverett @GastronautIan and colleagues. bit.ly/47s0Rkg
@BSGTrainees @PhilSmithIsBack @sheiybani @VivekGoodoory @RexWHHui @DunnePdj @DrJMKennedy @MohsenSubhani
Great data from Glasgow. 21.6% new HCC did not have underlying cirrhosis. Non cirrhotics older at diagnosis but survival unaffected unless underwent TACE which was more beneficial for the non-cirrhotic group.
From our latest issue: Read this new article on HCC epidemiology in the UK
@sheiybani @DrJMKennedy @DunnePdj @MohsenSubhani @RexWHHui @RMBeattie50 @PhilSmithIsBack
bit.ly/3MhRCJR
Philip Dunne retweeted
Can lumen-apposing metal stents make a difference to the management of severe acute pancreatitis? See below for the answer! 👇
bit.ly/4f6Z4EK
@drlak19 @sheiybani @MohsenSubhani @VivekGoodoory @DunnePdj @DrJMKennedy @RexWHHui @RMBeattie50 @PhilSmithIsBack
Philip Dunne retweeted
It's time for the next #FGDebate! It's time to talk seriously about how we can implement sustainability into hepatology practice with some fantastic advocates for #greenhepatology
@jamesbmaurice @MhairiDonnelly
Read the paper in advance and get involved! bit.ly/3W7JAsV
@sheiybani @MohsenSubhani @DunnePdj @DrJMKennedy @RexWHHui @BASLedu @BSGTrainees
