Day :
- Track-1 : Inflammatory Bowel Disease Research vs Treatment / Management
Track-2 : Treatment for Functional GI disorders
Chair
Debby Laukens,
Ghent University, Belgium
Co-Chair
Fratila Ovidiu,
University of Oradea, Romania
Session Introduction
Lu Liu
University of New South Wales, Australia
Title: Current advances in inflammatory bowel disease research
Time : 11:55- 12:25
Biography:
Lu Liu completed her PhD in Monash University, Australia in 1998, and received the prestigious Mollie Holman Medal for best PhD thesis. From 1998-2005, she worked as a Post-doctoral research officer and senior research fellow in the gastrointestinal pharmacology research field at UNSW Australia. In 2006, she took up an academic position, became a Lecturer in the same institution and was promoted to Senior Lecturer in 2009. As a Chief Investigator, she has obtained research funding over $2.5 million from various grant bodies to support her research. She has established a track record of quality research outputs. She has published over 50 original research papers in high impact pharmacology, gastroenterology and urology journals and over 130 conference abstracts. Her research has been recognized both nationally and internationally. She received many awards and has been frequently invited to present at the conference symposia and seminars.
Abstract:
Inflammatory bowel disease (IBD) is a chronic and debilitating gastrointestinal disorder, characterized by excessive inflammation within the gut wall with severe sequelae. In the majority of cases the etiologies of IBD are unknown, and conventional therapies have not been sufficiently effective. In order to improve health-related quality of life and well-being of patients, it is necessary to develop further therapeutic options. In addition to act as an energy source within cells, the purine nucleotide ATP can also be released from cells and functions as an autocrine/paracrine signal, modulating a broad range of cell and organ functions and contributing to disease processes, e.g. inflammation, through activation of purinergic P2X and P2Y receptors. The mechanisms responsible for ATP release have remained unresolved, although considerable evidence suggests that pannexin and connexin channels are ATP permeable conduits for the release of intracellular ATP into the extracellular space. Our new data have shown that pannexin and connexin channels are localised to intestinal epithelial cells and lamina propria immune cells, and mediate stretch- and/or Ca2+-dependent ATP release from human colonic mucosa and epithelial cell lines. We found that the purinergic P2X7 receptor, a key player in proinflammatory interleukin (IL)-1β processing and release, had a similar expression profile, suggesting that ATP released from these channels may act as an autocrine or paracrine molecule to activate P2X7 receptor, and thereby be a key factor underlying inflammatory responses. We also found that the P2X7 antagonist and pannexin-1 channel inhibitor could block TNFα and IL-1β induced reduction in transepithelial electrical resistance. These new findings provide a potential avenue for the development of novel therapeutics that targets P2X7 receptor and ATP release channels.
Biography:
Mohamed A Abeid has completed his MD/PhD degree from Cairo University School of Medicine and did his Postdoctoral endoscopy fellowship hands on training at the UCL, London, UK. He is a consultant gastroenterologist Cairo university school of medicine; training young doctors (Egyptians & non-Egyptians from Sudan, Yemen, Kuwait, Syria, Iraq, Libya, Tunisia, etc.) at the Endoscopy Unit Cairo University. He is a member of the European & American society of Gastrointestinal Endoscopy (ESGE, ASGE). He has published two cases in the GIE journal (ASGE) & BMJ case reports. He has been the Educational councilor of the Egyptian Society for the Study of Endoscopy and Hepatogastroenterology (ESEHG) responsible for medical updates (2009-2013).
Abstract:
Endoscopically placed intragastric balloons (IGBs) for the treatment of obesity were first introduced to the U.S. market in 1985 with the Garren-Edwards Gastric Bubble (GEGB). The GEGB was associated with multiple adverse events including gastric mucosal damage and small-bowel obstruction related to spontaneous balloon deflation with migration into the small bowel. This necessitated endoscopic or, more commonly, surgical retrieval of the migrated balloons. In addition, the GEGB failed to demonstrate efficacy in a prospective, double-blind, sham-controlled, randomized trial of 59 obese patients with a 9-month follow-up period. These issues resulted in its withdrawal from the U.S. market. In the early 1990s, the BioEnterics Intragastric Balloon (BIB) (Allergan, Irvine, Calif), currently known as the Orbera Intragastric Balloon (Apollo Endosurgery, Austin, Tex), was developed. The Orbera is an elastic spherical balloon made of silicone, filled with 450 to 700 mL of saline solution. The deflated balloon comes preloaded on a catheter, which is blindly advanced transorally into the stomach. An endoscope is then advanced alongside it to ensure accurate placement of the balloon in the fundus. Under direct visualization, the balloon is then inflated by injecting saline solution mixed with methylene blue through the external portion of the catheter. If inadvertent balloon rupture occurs, the methylene blue is systemically absorbed, causing a change in urine color, which serves as an alert that the balloon has deflated. The Orbera balloon is currently used in many countries outside the United States and is typically implanted for 6 months and then retrieved endoscopically. Newer IGBs with different migration-hindering and deployment/retrieval mechanisms and some that allow for endoscopic balloon volume adjustments are now available.
Akeel Alisa
Royal Free NHS Foundation Trust, UK
Title: Single-centre clinical experience of Hemospray Endotherapy in patients with Acute Upper Gastrointestinal Bleeding
Time : 13:55-14:25
Biography:
Akeel Alisa was awarded his medical degree from Cambridge University, Girton College. He is trained at various leading London hospitals including King's College, University College London and St George's and gained experience in all aspects of Gastroenterology, Hepatology, Endoscopy and General Medicine. He was awarded Membership of the Royal College of Physicians (London) in 1998 and received his MD from UCL in 2012. He was appointed as a Consultant Gastroenterologist & General Physician at The Royal Free NHS Trust, Barnet & Chase Farm Hospitals. He is local lead in alcohol services and endoscopy training. He is faculty member at St George's National Endoscopy Training Centre & United European Gastroenterology(Vienna).
Abstract:
Introduction: Acute upper gastrointestinal bleeding (AUGIB) is a common medical emergency associated with a hospital mortality of 10%. Therapeutic endoscopy with conventional combined injection and mechanical application is the recognised 1st-line intervention to achieve haemostasis. However, 5-10 % of patients experience recurrence of bleeding after initial endoscopic haemostasis. Hemospray (TC-325; Cook Medical, Winston-Salem, USA) endotherapy is now becoming widely available as a novel agent to augment hemostatic efficacy. We report on the ‘real-life’ single-centre experience in the UK, of the efficacy and safety of Hemospray in the management of AUGIB. Method: A single centre retrospective analysis of all patients treated with Hemospray from September 2013 -April 2015 was performed. Case notes were reviewed and data collected including demographics, Rockall score, endoscopic modality, length of hospital stay, repeat procedures and transfusion requirements. Results: 58 patients (42 male) with a mean age of 64.7 years (range 26-92) were treated with Hemospray at endoscopy. The indications for endoscopy were melaena (29, 50 %), profound anaemia (16, 28 %), haematemesis (6, 10%), oesophagogastric varices (5, 8.6%), dysphagia (1, 1.7%), dyspepsia (1, 1.7%). The mean pre-endoscopy Rockall score was 3 (range 0-7), post-endoscopy Rockall score 5 (range 1-10). Hemospray was applied as the single modality in 16 cases (2 oesophageal tumours, 4 gastric tumours, 4 peptic ulcers, 1 peptic stricture, 1 Dieulafoy lesion, 1 unidentified D2 bleeding source). Adjunctive modality occurred in 31 cases (54.8% following variceal band ligation as the primary modality). 11 cases required rescue therapy (10 peptic ulcers, 1 polyp bleeding). Successful haemostasis with Hemospray was achieved for all but one patient (98.3%). This patient (Dieulafoy lesion with Hemospray as solitary modality) required repeat endoscopic dual therapy (adrenaline/clips). 2 cases of bleeding DU required Hemospray despite radiologic embolization of oozing visible vessels. No procedural complications during and immediately post-application were reported. There were no treatment-related adverse events. There was one in-patient death, not attributable to AUGIB/endoscopy. The mean length of hospital stay was 12 days (range 1-51). Conclusion: Our experience confirms Hemospray to be an effective endoscopic modality for achieving successful haemostasis in the vast majority of cases of AUGIB, when used as single, adjunctive, or rescue endotherapy, for a wide-range of causes for AUGIB. Our ‘real life’ single centre UK experience supports Hemospray for all major causes of AUGIB; a modality that is easy to apply, and safe to use.
Debby Laukens
Ghent University, Belgium
Title: Targeting the development of intestinal fibrosis in Crohn’s disease
Time : 14:25-14:55
Biography:
Debby Laukens graduated as a biochemist from the University of Antwerp (Belgium) and obtained a PhD degree at Ghent University (Belgium) on “Transcriptome Profiling and Genetic Analysis to Identify Susceptibility Genes for Crohn’s Diseaseâ€. She completed Postdoctoral studies at theUniversity Hospital in Ghent and today, she is group leader of the IBD research unit at the department of Gastroenterology, which focusses on pre-clinical research related to inflammatory bowel diseases. She has published more than 50 papers in reputed journals in the field of gastroenterology.
Abstract:
Intestinal fibrosis is a common complication of Crohn’s disease. Fibrotic strictures are the most important indication for surgery and current therapies do not prevent their development. Due to the lack of anti-fibrotic therapeutic options, patients with a fibrostenosing phenotype (roughly 30% of cases) will progressively develop narrowing of the intestinal lumen, leading toclinically overt obstruction over time. Crohn’s-associated remodeling of the intestinal bowel wall is a complex cascade that is initiated by epithelial damage and activation of innate and adaptive effector cells, which trigger the recruitment and activation of fibroblasts that reorganize the extracellular matrix. The chronic nature of inflammation ensures sustained fibroblast activation, and together with reduced sensitivity of this fibroblast to apoptosis and their further induction by mechano transduction, this process results in disorganized, excessive extracellular matrix deposition, and finally stiffness of the bowel wall. We recently provided promising pre-clinical evidence that the inhibition of Rho kinase (ROCK), a key mediator in TGFß-induced activation of fibroblasts, harbors potent anti-fibrotic action. In spontaneous hypertensive rats, soft ROCK inhibition induced no cardiovascular effects at 10 mg/kg p.o, and daily treatment of mice did not induce toxicity. In the chronic DSS-induced model of colitis, as well as in the adoptive T cell transfer model, intestinal fibrosis develops only marginally in treated mice, which is associated with reduced colonic protein levels of pro-fibrotic cytokines IL6, IL13 and TGFï¢1-2, andattenuated production of matrix metalloproteinases 2, 3 and 9. Both in vivo and in vitro data show decreased activation of colonic fibroblasts in the presence of ROCK inhibitors, whereas manifest autophagy is induced. Finally, we observe little or no effect of ROCK inhibition on inflammatory markers/cell activation, suggesting direct anti-fibrotic action and its use as an add-on therapy for patients who are at risk to develop stenosis.
Quintin H González
University of Alabama, USA
Title: Primary fistulotomy and surgical drainage abscess is associated with low fistula recurrence rate
Time : 14:55-15:25
Biography:
Q H González was Graduated MD by the Autonomous University of the State of Mexico (UAEM) and got his best average distinguished with the prize Up John to the academic excellence and the medal Ignacio Ramirez. He did his post-graduation in General Surgery in the National Institute of Nutrition Salvador Zubirán, distinguished as chief residents. He is a Sub specialist in Colorectal and advanced laparoscopic surgery in The University of Alabama At Birmingham, USA, distinguished as outstanding international school, certified by the Mexican boards in General Surgery, gastrointestinal surgery and the Mexican Board of specialists in diseases of the colon, rectum and anus. He is the past president of Mexican collage of coloproctology, distinguished as Doctor Honoris Causa in health at Perú in 2013. He is a member of Mexican Academy of surgery and national Academy Medicine and American Society of colon and rectal surgery, author of 70 articles published in indexed journals more than 300 conferences by invitations, 43 abstracts and 36 posters.
Abstract:
Background: Most of the anorectal abscess has a cryptogladular origin different forms of treatment as antibiotics, needle aspiration or drainage with local anesthesia are associated with high rate of recurrence and development of fistula. There are few literatures regarding the one stage management performing drainage with identification of primary hole and fistulotomy. Aim: To analyze a retrospective series of 90 cases of anorectal abscess in terms of surgical outcomes with focus in recurrence and development of fistula tract. Material and Methods: During the period June 2011 to April 2015 a total 90 patients were included, they had an average age of 39 years old (range 19-73 ), according with the location were 49% isquiorectal , posterior 29%, anterior 19% and horseshoe 3%, with predominance of male n=67 (77%), patients were treated in several private tertiary care hospital HMG Coyoacan predominantly (48.1), time operative, bleeding, time of healing, recurrence, age and sex was analyzed. Results: The mean age was 39 years old (range 19-73 ) with a predominance of male sex (77%), mean of surgical bleeding was 15ml, hospital stay of 1 day (100%), operative time 19.8minutes (range 15-20), time of recovery was 14 days and time of healing 20 days, recurrence 2.5% (2 patients), requiring a new fistulotomy , the pain was controlled with paracetamol 750 mg three times a day alternating with ketorolac 10 mg three times a day orally and antibiotic amoxacilin-clavulanic acid 875 md twice/day during 10 days. Conclusions: This study shows that performing both procedures drainage and fistulotomy the incidence of fistula is very low, therefore we recommend in abscess with cryptoglandular origin; this approach which potentially decrease another surgery in the future.
Mohamed El-Kurdi
Al-Azhar University, Egypt
Title: Jejunal diverticulosis : A rare type of gatsrointestinal diverticulosis
Time : 15:55-16:25
Biography:
Mohamed Mohamed Abd El-Rahman EL-Kurdi has completed his MD at 1995 from Al-Azhar University Cairo, Egypt and Postdoctoral fellowship at 1997 from UCSD, USA. He is the Head of General Surgical Unit specialized in Biliary Surgery at Al-Azhar University Hospitals. He has published many papers in Arab Medical journals.
Abstract:
Diverticulosis of the jejunum is a rare condition with an incidence ranging from 0.1% to 1.5% in upper gastrointestinal studies. These are false diverticula occurring mainly in an older age group. Jejunal diverticula are usually found incidentally at laparotomy or during an upper gastrointestinal study the great majority remains asymptomatic. Acute complications can occur but are rare. This case report describes the case of a 56-year-old symptomatic man who underwent abdominal exploration for suspected intestinal obstruction by abdominal examination and abdominal erect X-ray. Intra-operatively diagnosis of jejunal diverticulosis was made. The preoperative diagnosis of this rare condition is difficult to make. However, with advances in gastro-intestinal imaging and with heightened awareness of this disease, fewer patients will need to undergo operative intervention as most patients are asymptomatic. The authors review the different imaging modalities available to help diagnose this condition and highlight the importance of being aware of this rare disease.
Fratila Ovidiu
University of Oradea, Romania
Title: The assessment of Tuberculosis risk in patients with inflammatory bowel disease and biological therapy
Time : 16:25-16:55
Biography:
Ovidiu Fratila completed his MD and Ph.D. at “Iuliu Hatieganu†University of Medicine from Cluj-Napoca Romania. He is Associated Professor at University of Oradea and Head the Internal Medicine Department from Emergency Clinical County Hospital from Oradea. He has published many papers in well known journals and also several books in the field of Internal Medicine and Gastroenterology. He is participating actively in many renowned international conferences and congresses. He is also involved in conducting clinical trials especially concerning inflammatory bowel disease. He is member in many European profile societies like European Society of Gastrointestinal Endoscopy, European Association for the Study of the Liver, European Society of Digestive Oncology, European Society of Digestive Oncology, European Crohn’s and Colitis Organisation. Currently, Dr. Ovidiu Fratila is also a distinguished member of the Russian Academy of Natural Sciences.
Abstract:
Tuberculosis remains a major health problem worldwide, with the emergence of multidrug-resistant (MDR-TB) or highly resistant (XDR-TB) Mycobacterium tuberculosis. Also, it is estimated that one third of the world population has latent TB infection. Patients with Crohn's disease and Ulcerative Colitis that are treated with anti TNF-alfa agents, have a 14 times higher risk of reactivation of latent TB than healthy subjects. Latent TB reactivation occurs mostly during the first year of anti TNF treatment, with a short median reactivation time to infliximab (3-6 months), compared with adalimumab (8-16 months). When TB occurs in patients receiving anti-TNF, it is usually atypical (extrapulmonary in 50%, disseminated in 25% of cases), making diagnosis more difficult. This is particularly important because the mortality in TB patients during the anti-TNF therapy has been reported to reach up to 13%. To reduce this risk we have three means at hand: screening is the most important mean, second is chimioprophylaxis and the third is careful monitoring of the patient. Therefore several key issues regarding current guidelines in the assessment of tuberculosis risk and its management will be discussed during this presentation. As a conclusion we can emphasize that the emergence of anti-TNF alpha therapy has provided a new therapeutic approach that is often "dramatically" efficient, but which also brought new concerns regarding security, its use being accompanied by the risk of reactivation of latent TB infection. Screening can reduce these risks but it cannot eliminate it completely which is why monitoring for latent TB reactivation in patients with anti-TNF therapy must be extremely vigilant.
- Track-3: Gastrointestinal Bleeding- Treatment and Management
Track-4: Gastrointestinal Carcinogenesis and Therapeutics
Track-5: Gastrointestinal Therapeutics Endoscopy- Advancements and Challenges
Track-6: Probiotics as Gastrointestinal Therapeutics
Chair
Ehab Abdelatty
Menoufia University, Egypt
Co-Chair
Cécile Besson Duvanel
Augurix SA, Switzerland
Session Introduction
Ernest Jehangir
North Cumbria University Hospitals, UK
Title: Colonic stenting for Malignant intestinal obstruction is a safe and effective method for bridging to surgery and palliation
Time : 11:20-11:50
Biography:
Ernest Jehangir had completed his undergraduate medicine at the Christian Medical College Vellore India and post graduate surgical training in Newcastle, UK. He is a colorectal surgeon and served as the surgical tutor and clinical tutor.
Abstract:
Colonic stenting using a TTS delivery system is a safe and effective means of treatment for intestinal obstruction caused by adenocarcinoma in the acute or urgent setting. It can be used as a bridge to surgery effectively converting an emergency open operation to an urgent laparoscopic resection. It is very effective in treating colonic obstructions in the palliative setting. This 12 year experience of nearly 100 cases show that it can be achieved in a District General Hospital and one of the highest series in the UK.
Sangeeta Agrawal
Wright State University, USA
Title: Medical management of upper GI bleed
Time : 11:50-12:20
Biography:
Sangeeta Agrawal is an Associate Professor of Medicine, Chief of Division of Gastroenterology, and GI Fellowship Program Director at Wright State University. She is also the Section Chief of Gastroenterology at Dayton VA Medical Center. She earned her medical degree from Gandhi Medical College, Osmania University, Hyderabad, India. She completed her Internal Medicine residency and Gastroenterology fellowship at University of Missouri, Columbia, MO. She is a Fellow of American Gastroenterological Association, American Society of Gastrointestinal Endoscopy and American College of Gastroenterology. She serves as Chair of Education Committee of Ohio Gastroenterology Society and as a member of ACG Training Committee. Her research interests include biomarkers for early detection of esophageal adenocarcinoma, role of gut microbiota in gastrointestinal diseases, and Barrett’s esophagus. She has mentored several GI fellows, medical residents and medical students. She is also co-founder and member of advisory committee of a non-profit organization, Global Pragathi.
Abstract:
Upper Gastrointestinal Bleeding is a medical emergency that requires prompt medical and endoscopic management. It accounts for 7-8% of acute medical admissions costing about $2 billion annually in USA. The mortality remains around 3.5-10% despite medical and surgical advances. Recent reports have indicated a decrease in mortality rates both in USA and Europe. The objective of my talk is to discuss optimal management guidelines for management of patients with acute upper gastrointestinal bleeding and to identify high risk patients. I will also discuss the common causes of upper gastrointestinal bleeding and the role of endoscopy in the management of acute upper gastrointestinal bleeding.
Ehab Abdelatty
Menoufia University, Egypt
Title: New era of hemostasis (Hemospray: A magic powder)
Time : 12:20-12:50
Biography:
Ehab Abd-El-Atty has completed his PhD from Faculty of Medicine, Menoufia University, Egypt and Master degree of Medical Sciences from Faculty of Medicine, Catholic University, Leuven, Belgium. He is Professor of Internal Medicine, Hepatology and Gastroenterology, Faculty of Medicine, Menoufia University, Egypt. He has published more than 30 papers in reputed journals and has been serving as a reviewer of Menoufia Medical Journal (MMJ). He is a member of AASLD (American Association for the Study of the Liver Diseases), ESGE (European Society of Gastrointestinal Endoscopy) and EASL (European Association for the Study of the Liver).
Abstract:
Gastrointestinal (GI) bleeding is a common clinical problem and one of the most important emergencies in gastroenterology. UGIT bleeding may be due to general causes (Coagulation defects or Bleeding disorders) or local causes (Esophageal, Gastric lesions or duodenal lesions). Mortality rate is still high about 5%–10% in patients with peptic ulcer bleeding and about 15% in those with variceal hemorrhage. 5-10% of patients will not be initially controlled by endoscopic intervention or they will experience a recurrence of bleeding in the first 24 to 72 hours. Hemospray (TC-325) is a novel hemostatic agent for the treatment of uncontrolled gastrointestinal bleeding (Variceal hemorrhage, Peptic ulcer, colonic ulcer, bleeding malignant tumors). It is a hemostatic spray propelled by carbon dioxide under pressure, which can achieve rapid hemostasis 92-100% of the cases. The powder forms a barrier over the vessel wall, quickly stopping the bleeding and increases the local concentration and activating platelets and of clotting factors and enhances thrombus formation. It is not absorbed or metabolized by mucosal tissue (no risk of systemic toxicity). Hemostatic spray is safe, quick, simple and easy. It does not require very precise targeting such as deployment of hemoclips. It covers a large surface area as bleeding malignant tumors. The effects of the spray disappear within 24 h to 72 hour. It stops uncontrolled GIT bleeding in 93-100% of cases. Hemospray appears to allow safe control of acute bleeding and may be used in high-risk cases as a temporary measure or a bridge toward more definitive therapy.
Bandipalyam V Praveen
Southend University Hospital, UK
Title: Posterior Pelvic Floor Dysfunction : Causes, Consequences and Cures
Time : 13:50-14:20
Biography:
Bandipalyam V Praveen has qualified in Medicine in 1987 from Bangalore University, India securing a Merit Scholarship and University Gold Medal. He then did his Postgraduate Surgical Residency program at PGIMER, Chandigarh, India leading to MS degree in 1990. He did his Higher Surgical Training in London in Colorectal Surgery when he was awarded the Dean’s Best Teacher award (2002) by the Royal Free UCL Medical School. He was appointed as a Consultant Surgeon at Southend University Hospital in 2003 where his present roles include: Clinical Audit, Research and Governance Lead, Chair, Clinical Governance Group, Chair, Complaints Review Group, Lead Clinician, Pelvic Floor Services, Lead Surgeon, Anal Cancer, Chair, Anal Cancer MDT, Essex Cancer Network. He has held various educational and training positions including: Associate Director of Medical Education from 2007-2011, Accredited Medical Appraiser, Educational and Clinical Supervisor, Hon Clinical Senior Lecturer, Queen Mary University of London and University of Edinburgh, Faculty member, Masters Course in Surgery (Robotics), Anglia Ruskin University. He is a Member of Court of Examiners, Intercollegiate MRCS Examinations of the Royal College of Surgeons. He has co-authored four books and has several international presentations and publications.
Abstract:
Posterior Pelvic Floor Dysfunction (PFD) can be disabling with severe effects on the quality of life (QOL). The symptoms can be varied and hence increased awareness and low threshold to investigate would lead to early diagnosis and appropriate treatment. The natural course is usually towards deterioration in symptoms with gradual progression of the problem. The underlying cause for the dysfunction can be neurogenic, muscular or mechanical. A combination of these may also be present. Contributory factors such as obstetric injuries, BMI, mental stress, psychiatric states, surgical procedures, diet, medications and life style may be important. The usual symptoms are fecal incontinence, evacuatory dysfunction, rectal prolapse and pelvic pain. A combination of these may also occur. Initial assessment should include standard pro-formas, symptom scores and QOL impact questionnaires. Physiology tests to evaluate the anorectal function will help to know the underlying problem and formulate the treatment plan. Management is multi-disciplinary and involves doctors, physiotherapists, specialist nurses, dieticians, pain specialists, stoma nurses and psychologists. Initial treatment is usually non-surgical in the majority of these patients and may involve treatments such as Biofeedback, Anal irrigation and neuro-modulation. Surgery is reserved for the small group of patients who continue to have persistent symptoms which significantly affect their QOL. The expectations of the patient from the operation should be discussed pre-operatively and ensured that the goals are realistic. Cases are best discussed in Pelvic MDT pre-operatively and counseling should include success rates, the possibility of some symptoms still continuing despite surgery, specific procedure related risks and long term recurrence rates. Overall, correct identification and treatment of the pelvic floor dysfunction can lead to improvement in QOL and grateful patients while a failure to identify this can lead to unnecessary operations and a life of misery.
Yusuke Saitoh
Asahikawa Medical University, Japan
Title: Endoscopic diagnosis and treatment for early colorectal carcinomas- Advancements and challenges
Biography:
Yusuke Saitoh completed his MD and PhD from Asahikawa Medical University, Asahikawa, Japan. He stayed in Texas, USA and did research on flat and depressed type colorectal tumors. He has received many honors and awards. He is a distinguished Director at Asahikawa City Hospital and clinical Professor in Asahikawa Medical University. He is also a manager of the Hokkaido prefecture branch of Japan Gastroenterological Endoscopy and Editorial Board Member of Stomach and Intestine (traditional Japanese Journal in regard to gastrointestinal diagnostic and therapeutic endoscopy). He has been invited from 13 countries and performed more than 30 lectures and live demonstrations so far.
Abstract:
Since recent advancement of endoscopic therapeutic technology, the numbers of endoscopic resection for early colorectal carcinomas with little risk of lymph node metastasis is increasing. There have been no reports of lymph node metastasis in intramucosal (Tis) carcinomas, while lymph node metastasis occurs in 6.8–17.8 % of submucosal (T1) carcinomas. Three clinical guidelines have been published in Japan and the strategy of the management for early colorectal tumors is demonstrated. According to 2014 JSCCR Guidelines for the Treatment of Colorectal Cancer, among endoscopically treated carcinomas, T1 carcinoma with a histologically diagnosed as a positive vertical margin should be performed additional surgery. Additional surgery may be considered when at least one of the following histological findings is detected: i) SM invasion depth ＞1,000 μm; ii) histological type of por., sig., or muc.; iii) budding grade 2-3; and iv) positive vascular permeation. While resected lesion is histologically diagnosed as a T1 carcinoma without any histological findings mentioned above, it could be followed up without additional surgery. In order to accomplish complete endoscopic resection with both vertical and horizontal margin negative, ESD is a reliable technique for en block resection regardless of lesions size compared with conventional EMR. It has been discussed about the possibility of the endoscopic total excisional biopsy for T1b carcinomas using NBI or EUS. As for the prognosis of endoscopically resected T1 carcinomas, relapse ratio is relatively low as about 3.4% (44/1,312), but prognosis was poor as 72 of cancer death out of 134 relapsed cases (54%) once relapse has occurred. It is expected that more detailed stratification of lymph node metastasis risk after endoscopic resection for T1 carcinomas and the prognosis of relapsed cases in a prospective fashion will become apparent, and appropriate indication of endoscopic resection including total incision biopsy for T1 carcinomas will be established.
Tomaz Jagric
Maribor Medical School, Slovenia
Title: The flow cytometric study of immune modulation in the Sentinel lymph nodes of Gastric cancer patients
Time : 14:50-15:20
Biography:
Tomaz Jagric completed his MD and PhD from medicine and general surgery in Slovenia and Postdoctoral studies from Ljubljana Medical School. His main field of expertise is the upper gastrointestinal, hepatico-pancreato-billiary and laparoscopic gastric cancer surgery. He has been habilitated as assistant researcher on Maribor Medical School in Slovenia, and has since been working as the head researcher on many projects. Currently he is leading two projects “Flow cytometric detection of micrometastases in the sentinel lymph nodes of gastric cancer patients†and “Detection of Free tumor cells in abdominal lavage fluids of patients with advanced gastric cancer as a selection marker for hyperthermic intraoperative intraperitoneal chemotherapyâ€. He is also conducting several trails of negative pressure therapy in abdominal compartment syndrome as well as palliative rectal cancer stenting and stenting of malignant obstructions in gastric cancer patients.
Abstract:
Background: We introduced a novel method of intraoperative downstream LN metastases prediction with focused sentinel lymph node flow cytometry analysis. With this method we could detect SLN metastases as well as alterations in local immune response indigenous to metastatic involved SNLs. These alterations allowed an even more precise detection of downstream LN metastases. Aim: The aim of our study was to determine whether accumulation of CD25high CD127low expressing activated regulatory T lymphocytes in SNLs could predict downstream lymph node metastases. Methods: Thirteen patients with histologically verified adenocarcinoma of the stomach were included in our study. Intraoperative subserosal Patente Blue V dye injection was used for LN navigation. The first blue lymph node was extracted for intraoperative analysis. The SNL was halved, with one half for frozen section and the other half for flow cytometry analysis. The flow cytometry was used to detect CEACAM and EpCAM expressing tumor cells and CD25high CD127low expressing cells. Results: From thirteen included patients, sixwere node positive on final histology. With the frozen section analysis only three from six node positive patients could be determined during the operation. Similarly, CEACAM/EpCAM expressing cells could be found in three from six node positive patients with flow cytometry. However, in all six node positive patients the SLNs contained lymphocytes in the CD25high CD127low region representing activated regulatory T lymphocytes. From 7 node negative patients only one patient had SNL containing CD25high CD127low expressing cells. The ROC analysis determined presence of CD25high CD127low cells in SNLs as a significant predictor for downstream LN metastases (AUC 1; p = 0.002). Conclusion: The detection of CD25high CD127low expressing cells in SNL is an accurate predictor of downstream LN metastases.
Skerdi Prifti
Medical University of Tirana, Albania
Title: Helicobacter pylori, peptic ulcer, and gastric cancer in Albanian population
Time : 15:50-16:20
Biography:
Skerdi Prifti completed MD in 1986 and PhD from the Faculty of Medicine, University of Tirana, on 1995. He received two Fulbright Scholarships on 1995 and 2001 at Georgetown University, Washington DC for diagnostic and therapeutic endoscopy. He has been involved in several international collaboration studies on Helicobacter pylori with Herlev Hospital, Copenhagen, University of Bordeaux, France and Naval Institute, Bethesda, Maryland. He was the President of the Albanian Association of Gastrohepatology during 2009-2011. He is the Professor of Medicine since 2011 at the Medical University of Tirana and Chief of Endoscopy Unit at Gastrohepatology Department, University Hospital Mother Theresa, Tirana, Albania. He is the author and co-author of one American and several Albanian textbooks chapters.
Abstract:
Helicobacter pylori (Hp) are considered the main factor of ulcer genesis and a primary carcinogen for gastric cancer. The overall presence of this bacterium reflects the social-economic and hygienic condition of a certain population. The prevalence of Hp is higher in developing countries, but the range of infection still differs among them. Prevalence of Hp in Albanian population, based on data of the beginning of the ’90-es is between the highest in Europe (90-100%), demonstrated on studies on adult and children population. Higher frequency of Hp infection has been seen compared with Western populations (Denmark). There was also demonstrated that the Albanian strains of Hp are more aggressive compared to the strains of Western patients (USA). Therefore the Albanian population has suffered of a high incidence and prevalence of Peptic Ulcer through the last decades, associated with a high number of admissions and surgical complications. By the other side, based on hospital admissions, endoscopies performed, and national data (WHO), Albanian population has one of the highest incidence, prevalence and death rate from gastric cancer in Europe. After twenty years of political transition, change of economic system, and social-economic improvement, there seem to be a tendency of decrease of Hp infection in our country (=/<70%). In the same time, there is a decline of Peptic Ulcer frequency, hospital admissions and number of operations, while incidence and prevalence of Gastric Cancer remains high, with many cases affecting young adults. We may speculate that the decline of the incidence of peptic ulcer but not of the gastric cancer on the Albanian population reflects the natural history of gastro-duodenal diseases due to the Hp infection.
- Track-7: Recent Advancements and Current Research in Gastrointestinal Therapeutics
Track-8: Clinical Nutrition in Gastrointestinal Diseases
Chair
Larry I Good
Good Pharmaceutical Development Company, USA
Co-Chair
Marcela Hermoso R
University of Chile, Chile
Session Introduction
Larry Good
Good Pharmaceutical Development Company, USA
Title: Serum-Derived Bovine Immunoglobulin in the Management of Chronic Gastrointestinal Disease
Time : 10:00- 10:30
Biography:
Larry I Good has been a practicing Gastroenterologist since 1978. He has graduated Colgate University Magna Cum Laude in 1969 and received his MD with Alpha Omega Alpha status from the Medical University of South Carolina in 1973. He was a fellow trained in Gastroenterology from 1976-78 at the University of Pennsylvania. He has served as the Director of Liver Diseases at Nassau County Medical Center and was for many years Chief, Department of Medicine at South Nassau Communities Hospital. He is an Assistant Clinical Professor of Medicine at SUNY Stony Brook. He was the Chief Medical Officer at Ritter Pharmaceuticals in Los Angeles and his current clinical research activities involve the microbiome, inflammatory bowel disease, irritable bowel syndrome and the application of orally administered gamma globulin to patients with acute and chronic gastro-intestinal disorders. He has Founded Good Pharmaceutical Development Co., LLC, in 2014. He was recently appointed CEO of Compassionate Care Center of New York. He was appointed as an Editor of BMC Gastroenterology, a prestigious on line peer reviewed medical journal. He is a Member of the Speakers Bureau for Entera Health, Abbvie and Cubist Pharmaceuticals.
Abstract:
Serum-derived Bovine Immunoglobulin (SBI) possesses the entire immune experience of cows. Oral administrations of SBI prepared from the serum of lots of 3000 cows at the time of slaughter has been demonstrated to be effective in the management of HIV enteropathy, diarrhea predominant irritable bowel syndrome, ulcerative colitis, Crohn’s Disease, pouchitis and C. difficle colitis. Data will be presented of clinical outcomes from randomized, double blind trials and observational studies. Mechanism of action of this product includes binding of pro-inflammatory intra-luminal bacterial degradation products, pro-inflammatory cytokines, bacterial endotoxins and tightening of tight junctions between intestinal epithelial cells. The excellent safety profile and GRAS status of this medical food product will be discussed.
Yasser Negm
Al Zahra Hospital, UAE
Title: The last 5 years and the next 5 years : Gastro-esophageal reflux disease (GERD) – An update
Time : 10:30-11:00
Biography:
Dr Yasser Negm currently works as a Pediatric consultant with interest in Pediatric Gastroenterology at Al Zahra Private hospital, Dubai, UAE. He has 8 years of experience in the field. He is a member of the British society of Pediatric Gastroenterology, Heptology and Nutrition. His UK Pediatric Gastroenterology training units in London included Great Ormond Street, King’s college, The Royal London and the Royal Free Hospitals. He completed his training in Pediatrics in 2012, as recognised by the Royal College of Paediatrics and Child Health and the General Medical Council. During his work in the Pediatric Gstroenterology unit at Great Ormond Street Hospital, Dr Negm won the prize of the most outstanding lecture of the year 2010.
Abstract:
The incidence of GERD is progressively increasing all over the world, even within the Paediatric age groups. It is highest among infants and older female adolescents. Children with neurological impairments and other co-morbidities are at increased risk. It was diagnosed in 12.3% of North American infants and in 1% of other paediatric age groups. There is obviously a major effect on the daily life of caregivers and on health care costs which have been estimated to be US $2386 per patient per 6 months (2009 estimate). Over the past 5 years, significant changes have been increasingly developing and reshaping not only the way we should treat GERD, but also new definitions, methods of diagnosis, aetiologies contributing to the pathology, guidelines from specialist bodies, research studies looking for evidence and even newly discovered side effects of the traditional treatments. Through this presentation, I’ll share with the audience both the raw and ripe fruits of recent experts’ work, especially those developments supported with robust evidence, both at clinical and research levels. From directions of labs and clinical trials to trends of practice in tertiary centres, I’ll extend the presentation to explore as well the seeds of future management of GERD expected in the next 5 years.
Marcela Hermoso R
University of Chile, Chile
Title: The role of the novel IL33/ST2 system in the causation of ulcerative colitis
Biography:
Marcela Hermoso R is a Professor of Immunology at the Disciplinary Program of Immunology of the Institute of Biomedical Sciences, Faculty of Medicine, University of Chile, Santiago, Chile. Her research focuses on the pathogenesis of intestinal inflammation and how altered immune responses can promote the ensuing diseases.
Abstract:
ST2/IL33 signaling pathway has been related to many inflammatory disorders as well as inflammatory bowel disease (IBD). IL-33, an IL-1 family member, is expressed in many cell types and its nuclear localization regulates gene transcription. IL-33 is released upon necrosis and the precursor form is enzymatically processed to promote an inflammatory response as a damage-associated molecular pattern or alarmin. The IL-33 receptor ST2, encoded by IL1RL1, is expressed as both a membrane-anchored receptor (ST2L) activated by IL-33 and as a soluble variant (sST2) that exhibits increased anti-inflammatory properties in inflammatory conditions and has been proposed as a prognostic disease biomarker. We characterized the IL33/ST2 system in mucosa from IBD patients and the effect of clinical course and therapy on sST2 content and cellular distribution as predictive markers of response to treatment, disease activity and outcome. These are the first findings demonstrating molecular and cellular mechanisms on the regulation of ST2 system in mucosa inflammation. This conference will offer cutting edge biomedical data on recent advances in the role of ST2 in these diseases.
Vamseedhar Annam
Mamata Medical College, India
Title: Predictive and prognostic markers in colorectal cancers
Time : 11:50- 12:20
Biography:
Vamseedhar Annam completed his DCP and MD degree in Pathology from Rajiv Gandhi University of Health Sciences. He has received honor and awards for innovative research works in cytopathology and histopathology. He is a distinguished Professor [Pathology] and Research Advisory Board Member at Mamata Medical College [NAAC accredidated A grade Medical College] affiliated under Dr. N.T.R University of Health Sciences, Vijayawada. He has more than 40 publications in the form of original articles, review articles and case reports in the field of Oncology and Infectious diseases in various indexed journals like Journal of Gastrointestinal Cancer, Indian Journal of Cancer, Cytojournal, Indian Journal of Pathology & Microbiology, Journal of Biomedical Sciences, etc. Currently, he is working on predictive and prognostic markers in colorectal cancers.
Abstract:
Colorectal cancer (CRC) is one of the leading causes of cancer-related death in both men and women. The early and advanced CRC still remains a major health burden with a disease-specific morbidity and mortality worldwide. CRC can grow either inward towards the lumen of the colon or rectum and/or outward through the walls of these organs. Advanced disease can cause perforation of the bowel and lead to infection. Metastasis of the disease may occur to the lymph nodes, liver, lung, peritoneum, ovaries and brain. CRC has a complex pathogenesis, involving multiple sequential steps with accumulation of genetic alterations including gene mutations, epigenetic changes and gene amplification. Thus, the treatment of CRC has undergone a paradigm shift over the past decade due in part to a better understanding of the biology of disease and also development of newer drugs including biologic agents. In the era of evidence based medicine, it is attractive to investigate the molecular pathways leading to colorectal cancer tumorogenesis, thus raising the possibility of identifying novel therapeutic targets. The selection of the most beneficial treatment regimens in CRC is hindered by a lack of predictive and prognostic markers. Histopathological examination of tumor material can also help to define prognosis further, using resection margins, grade of the tumor, vascular invasion and metastasis. Hence, research on markers that may be useful predictors of response to treatment and prognostic markers to determine the aggressiveness of the disease and the likelihood of recurrence after surgery would be beneficial. Accordingly, the identification of accurate and validated predictive and prognostic markers combined with an increasing arsenal of therapeutic agents will provide the clinician with the knowledge and the means of tailoring a targeted and effective therapy.
Panel Discussion